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Am Fam Physician. 2000;61(4):1121-1122

Sore throat is one of the most common reasons for consultation with a family physician. More than one third of patients experience prolonged symptoms, with illness lasting more than five days after consultation. These patients are likely to make repeated visits and to experience morbidity and interference with daily activities. Little and colleagues used a network of British family physicians to study more than 700 patients who consulted a physician because of sore throat. One focus of their study was the influence of patient satisfaction with the consultation on duration of illness.

Physicians assessed 716 patients who presented with sore throat. Patients were randomly assigned to one of three treatment strategies: antibiotics, no antibiotics or delayed antibiotic therapy. Patients recorded their satisfaction with the consultation using standardized scales and assessed to what extent their concerns had been addressed. Patients also kept symptom diaries until the condition resolved. Resolution of symptoms was documented for 579 (81 percent) of the 716 participants.

Prolonged illness was noted in 36 percent of patients. Factors significantly related to a prolonged course of illness included age greater than 12 years, presence of cough, longer duration of illness before consultation and less satisfaction with the consultation. Sixty-nine percent of patients reported that their concerns were well dealt with during the consultation. Addressing patient concerns was the strongest predictor of patient satisfaction. Prescription of an antibiotic was weakly related to satisfaction. The degree of patient satisfaction with the consultation was strongly related to the duration of illness. Satisfaction with consultation predicted duration of illness independently of other variables. In turn, satisfaction was most closely dependent on effective physician-patient communication.

The authors conclude that discussion of the natural course of illness and attention to the patient's concerns significantly reduce the duration of illness in patients with sore throat. They urge physicians to effectively counsel patients with sore throat, particularly those with risk factors for prolonged illness.

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