Nearly one in four Americans have exaggerated or invented symptoms to obtain antibiotics from a doctor, either for themselves or for a child in their care, according to a study by researchers at University of Utah Health. The nationwide survey of nearly 1,000 people examined why patients and caregivers sometimes misrepresent symptoms and highlighted the need for better communication between healthcare providers and patients.
Published in JAMA Network Open, the study found that 28% of respondents had deliberately misrepresented their symptoms to obtain antibiotics for themselves. Another 27% reported doing so to get antibiotics for a child. These behaviours included exaggerating existing symptoms or inventing symptoms entirely.
The most common motivations included feeling extremely unwell, believing that antibiotics were the only effective treatment, and wanting to recover quickly enough to return to work or school. Some respondents also wanted greater control over their treatment decisions.
Alistair Thorpe, a research assistant professor of population health sciences at University of Utah Health and one of the study’s first authors, said the findings provide a clearer understanding of why people engage in this behaviour.
“Now that we have a clearer picture of how common these behaviors are and the reasons behind them, the next step is to look at strategies that help patients express their preferences and communicate what they’re feeling to their provider, and for their provider to hear them, understand their concerns, and reassure them,” Thorpe said.
He acknowledged that patients experiencing unpleasant symptoms may find it difficult to accept a recommendation to rest and wait for recovery when they believe medication could provide immediate relief.
Why Unnecessary Antibiotic Use Is Dangerous
Antibiotics are essential for treating bacterial infections, but they are ineffective against viruses, which cause many common respiratory illnesses, including colds and flu-like infections. Taking antibiotics unnecessarily can expose patients to side effects without providing the expected benefits.
Andrea Levy, a professor of social sciences at Connecticut State Community College Middlesex and another first author of the study, highlighted the wider consequences of inappropriate antibiotic use.
“These medications are not totally benign for the patient,” Levy explained. “And antibiotic use contributes to increasing antimicrobial resistance, which is a broader public health concern.”
Antimicrobial resistance develops when microorganisms evolve in ways that make medicines less effective against them. Unnecessary antibiotic use contributes to this problem, making it harder to treat certain infections.
Doctors therefore need accurate information about patients’ symptoms to determine whether antibiotics are appropriate. When patients exaggerate or fabricate symptoms, they may make it more difficult for healthcare providers to choose the safest and most effective treatment.
Previous Medical Experiences May Influence Patient Behaviour
The researchers emphasised that their findings should not be used to blame or distrust patients. Instead, they suggest that misrepresenting symptoms can stem from understandable concerns and previous experiences with healthcare providers.
Respondents were more likely to report exaggerating symptoms if a doctor had previously dismissed or downplayed their concerns. Such experiences may leave patients feeling that they must overstate their condition to receive attention.
Thorpe also noted that patients who recover after receiving antibiotics for a viral illness may mistakenly attribute their improvement to the medication. Since many viral infections resolve naturally, this experience can reinforce the belief that antibiotics are necessary whenever similar symptoms occur.
Levy stressed that understanding these motivations could help healthcare professionals develop better ways to address patients’ concerns.
“There are very understandable reasons that we can sympathize with about why patients might feel the need to misrepresent symptoms, or why caregivers might do so on behalf of their children,” Levy said. “We’re simply saying: perhaps there’s a better way.”
Better Communication Could Reduce Inappropriate Prescriptions
The researchers argue that improving communication between patients and healthcare providers is essential to reducing unnecessary antibiotic prescriptions. Doctors need to explain why antibiotics may not help in certain cases while ensuring patients feel their symptoms and concerns have been taken seriously.
Angela Fagerlin, professor and chair of the Department of Population Health Sciences at University of Utah Health and the study’s senior author, called for further research into communication strategies.
“Going forward, it will be important to test different ways to change the communication patterns between patients and their clinicians,” Fagerlin said. “How can clinicians communicate to patients the importance of not prescribing antibiotics when they won’t be effective, how can patients communicate in a way that their concerns and needs are met, and how can we help each other better understand the others’ perspectives?”
Levy cautioned against treating the findings as a reason for doctors to become suspicious of their patients.
“The practical takeaway is not for clinicians to become more suspicious of their patients,” Levy said. “Instead, clinicians need to create interactions where caregivers and patients feel heard enough that they don’t feel the need to exaggerate in order to be taken seriously.”
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