Rollnick S, Seale C, Rees M, Butler C, Kinnersley P, Anderson L
Department of General Practice, University of Wales, College of Medicine, Cardiff CF3 7PN, UK.
Fam Pract. 2001 Oct;18(5):506-10. doi: 10.1093/fampra/18.5.506.
The aims of this study were to examine how GPs manage the consultation for upper resiratory tract infections (URTIs) and the prescribing of antibiotics, to understand what skills and strategies are used in managing URTIs without antibiotics, and to note evidence of pressure on doctors to prescribe and whether there are signs of overt disagreement about prescribing in the consultation.
A qualitative analysis of audiotaped consultations was carried out. The setting was a general practice in South Wales and the subjects were five GPs and 29 parents presenting children with URTIs over a 2-week period. The main outcome measures were skills and strategies identified from audiotapes of consultations.
This group of GPs used a set of readily identifiable consulting skills for managing the consultation without prescribing. Their consultations had a highly routinized quality. There was little evidence of either conflict or overt pressure from parents to prescribe. The word 'antibiotics' was seldom mentioned. Clinicians did not elicit patient expectations for receiving antibiotics.
Doctors use a set of readily identifiable skills in managing the URTI consultation. Avoiding the prescribing of antibiotics is not necessarily a simple and straightforward matter. Since patients apparently want antibiotics less than anticipated, eliciting expectations might be a way of reducing prescribing and broadening the approach to meeting patient needs. Whether doctors can adjust their routinized consulting patterns in the time-limited context of general practice remains an open question.
本研究旨在探讨全科医生如何处理上呼吸道感染（URTI）的诊疗及抗生素处方，了解在不使用抗生素治疗URTI时所运用的技能和策略，记录医生在处方方面所面临的压力迹象以及诊疗过程中是否存在明显的处方分歧迹象。
对录音诊疗进行定性分析。研究地点为南威尔士的一家普通诊所，研究对象为5名全科医生以及在两周内带着患有URTI的孩子前来就诊的29名家长。主要观察指标是从诊疗录音中识别出的技能和策略。
这群全科医生运用了一套易于识别的诊疗技能来处理诊疗过程而不开具处方。他们的诊疗具有高度常规化的特点。几乎没有证据表明存在冲突或家长要求开具处方的明显压力。“抗生素”一词很少被提及。临床医生未了解到患者对抗生素治疗的期望。
医生在处理URTI诊疗时运用了一套易于识别的技能。避免开具抗生素并非一定是简单直接的事情。由于患者对抗生素的需求似乎低于预期，了解患者期望可能是减少抗生素处方并拓宽满足患者需求途径的一种方式。在普通诊所有限的时间范围内，医生能否调整其常规化的诊疗模式仍是一个悬而未决的问题。
