Family Practice Vol. 21, No. 5 © Oxford University Press 2004, all rights reserved.
Doi: 10.1093/fampra/cmh505, available online at www.fampra.oupjournals.org
Printed in Great Britain
Acute cough: a qualitative analysis of how GPs
manage the consultation when patients explicitly
or implicitly expect antibiotic prescriptions
Attila Altiner, André Knauf, Jette Moebes, Martin Sielk and Stefan
Altiner A, Knauf A, Moebes J, Sielk M and Wilm S. Acute cough: a qualitative analysis of how
GPs manage the consultation when patients explicitly or implicitly expect antibiotic pre-
scriptions. Family Practice 2004; 21: 500–506.
Objective. The aim of this study was to analyse how GPs manage the consultation for acute
cough when patients explicitly or implicitly expect antibiotic prescriptions.
Methods. A qualitative analysis of audio-taped consultations was carried out. The participants
were eight GPs from eight general practices in Northrhine, Germany and their 42 patients with
acute cough over a 2 week period. Three researchers analysed the consultations independently,
finally agreed by discussion.
Results. Implicit expectations for antibiotics were found frequently, but in none of the 42
consultations was the patient asked directly what she or he expected in terms of therapy. The
topic of expectations and demands itself normally was not discussed at all, not even in a non-
direct manner. In some consultations, the possibility of an antibiotic prescription was ruled out
by the GP from the beginning. In some consultations, even a ‘pseudo-consent’ was found,
avoiding any explicit clarification.
Conclusion. GPs seem to overestimate the actual pressure to prescribe antibiotics for acute
cough. The (over) prescription of antibiotics might not be a question of knowledge but a lack of
Keywords. Antibiotics, attitudes, consultation, prescriptions, upper respiratory tract
Received 26 September 2003; Revised 24 March 2004;
Accepted 17 May 2004.
Department of General Practice, University Hospital,
Heinrich Heine University Düsseldorf, PO Box 101007,
D-40001 Düsseldorf, Germany. E-mail: firstname.lastname@example.org_
Consultations for acute cough are one of the most
common in general practice. Despite the fact that
antibiotics have at best a marginal effect on acute
cough,1,2they are prescribed frequently.2–4Many doctors
are aware of this issue but feel that their patients urge
them to prescribe antibiotics.5,6In contrast, recent
studies described that only a minority of patients ask for
antibiotics, and patients do not want antibiotics as much
as their doctors think they do.6–8There seem to be
misconceptions as well as misunderstandings about
effective treatment of acute respiratory tract infections
(ARTIs) on the part of both patients and doctors.9–11
While many questionnaire and interview studies focused
on this phenomenon of a likely misunderstanding, the
actual patient–doctor interaction in encounters for
ARTIs only recently has become a topic of interest.12,13
The focus of this qualitative study is to provide an
inside view of the consultation for acute cough in
German general practice. We wanted to specify how
patients’ explicit and, even more cruciallly, implicit
expectations for antibiotic prescriptions are handled
within doctor–patient communication in Germany and
how they contribute to the process of decision making.
A sample of 10 GPs (four female and six male) working
in the Province of Northrhine, Germany, were asked to
take part in the study. In order to obtain a contrasting
range of consultation styles, we asked the top five highest
antibiotic prescribers as well as the five lowest antibiotic
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BF. Antibiotic use in acute respiratory infections and the ways
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17Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N.
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for sore throat. Br Med J 1998; 317: 637–642.
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Family Practice—an international journal
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