Empathy, burnout, and antibiotic prescribing for acute respiratory infections: a cross-sectional primary care study in the US

Bob Z Sun, Alexander Chaitoff, Bo Hu, Kathleen Neuendorf, Mahesh Manne, Michael B Rothberg

The impact of physician-patient relationship factors, such as physician empathy and burnout, on antibiotic prescribing has not been characterised. To assess associations between physician empathy and burnout and antibiotic prescribing for acute respiratory infections (ARIs) in primary care. Cross-sectional study of primary care practices in the Cleveland Clinic Health System in the US. Patient and prescribing data were obtained from the medical record. All patients with primary diagnoses of ARIs from 1 January 2012 to 31 December 2013, except those with chronic obstructive pulmonary disease (COPD) or who were immunocompromised, were included. Physician empathy was measured using the Jefferson Scale of Empathy while physician burnout was measured using the Maslach Burnout Inventory. The relationship between empathy and burnout and antibiotic prescribing, adjusted for patient and provider characteristics, was analysed using multiple linear regression. In 5937 ARI visits to 102 primary care physicians, the median proportion resulting in antibiotic prescribing was 48.6% (interquartile range [IQR] 24.1% to 70.0%). Neither physician empathy (correlation coefficient [β] 0.005, 95% confidence interval [CI] = -0.001 to 0.010, P = 0.07) nor any burnout measures were significantly associated with antibiotic prescribing: emotional exhaustion (β 0.001, 95% CI = -0.005 to 0.006, P = 0.79), tendency to depersonalise patients (β -0.009, 95% CI = -0.021 to 0.003, P = 0.13), and sense of personal accomplishment (β -0.004, 95% CI = -0.014 to 0.006, P = 0.44). The authors found no significant association between empathy or burnout measures and antibiotic prescribing for ARIs in primary care. Other physician characteristics should be investigated to explain individual variation in antibiotic prescribing.