A new study shows that, at least for antibiotic therapy, nearly 30% of patients “misrepresent” symptoms to get the antibiotics they desire. Why? Their reasons reveal something more troubling than inappropriate prescribing: a growing tension between medical expertise, patient autonomy, and the trust that once helped bridge the two.
"Everybody lies." – Dr. Gregory House.
While Dr. House served as a master diagnostician on television, as you can tell from this quote, which was essentially his credo, his bedside manner was not warm and fuzzy. A new study reported in JAMA Network Open tries to quantify how patients misrepresent their symptoms to physicians when seeking antibiotic prescriptions. Much has been written in the past about how some physicians will write the script even though the underlying cause is considered viral and therefore not an indication. More has been written about antibiotic resistance and the need for more careful “shepherding” of these medications to prevent long-term problems in treating serious bacterial infections for us all.
The Prescription Patients Expect Before Seeing the Doctor
The common cold, a mild upper respiratory disease often viral rather than bacterial in origin, involves symptoms of cough, sniffles, congestion—you know what I mean. It drives millions of individuals to seek more than over-the-counter care annually. A CDC survey found that:
- 42% of consumers expected reassurance during a visit for a cough or cold.
- 26% expected an antibiotic.
- 54% of healthcare providers believed their patients expected antibiotics
The dataset comes from a nationally representative sample of 959 US adults over age 18 designed to ensure broad representation across age, gender, race or ethnicity, and geographic region. The study assessed two specific forms of symptom “misrepresentation” in their quest to obtain antibiotics: exaggerating existing symptoms and fabricating nonexistent symptoms. The earlier CDC study, which I should note is based on a different US sample, shows that physicians were primed to expect antibiotic requests, and at least a quarter of those patients had expectations.
A Little Exaggeration Goes a Long Way
27.9% of respondents admitted to misrepresenting their symptoms to a clinician to obtain antibiotics. 26.0% exaggerated their symptoms, 16.7% fabricated them entirely, and a majority (52.6%) both exaggerated and fabricated. Fevers, coughs, and sore throats were the most commonly misrepresented conditions.
Roughly two-thirds of the patients who lied were confident that this would force the physician's prescribing hand. That confidence was not misplaced, as 76.9% of those who misrepresented their symptoms successfully obtained an antibiotic prescription at least once.
As a physician, I was far more interested in the why or why not. For the majority of respondents, the 70% of the truth-sayers, the overwhelming reason for being honest was the recognition that it was a requirement for appropriate care, followed closely by what I would consider a corollary: trusting their physicians.
The Ends Justify the Means
The “dirty thirty” had several reasons.
Some felt seriously ill longer than anticipated, and thought antibiotics were the best solution. Some couched their rationale in protecting others, getting back to their responsibilities, or attending an important event. From a public health perspective, perhaps we should focus more on the 50% who, knowing their body and medical history better than a health care provider, should “get to decide what treatments I need”—the medically autonomous seeking their own disease journey.
Some of those individuals felt that clinicians did not take their symptoms seriously, clearly a failing. Others questioned whether antibiotic resistance was real and whether it would affect them personally; a continuing echo from the pandemic and its ripple effects on beliefs around infectious disease and its treatment. My favorite rationale, a version of “a crisis is a terrible thing to waste,” is the 41% fabricating symptoms to get antibiotics for a future illness.
When Everybody Lies, Nobody Wins
Dr. House was a great diagnostician, but his relationships with patients were largely transactional. Increasingly, so are ours. As I have argued in the past, urgent care practices that do not attempt to align your visits with a specific physician, believing that all are equivalent, work against the time necessary to cultivate a trusting clinical partnership.
Historically, the asymmetry between physician expertise and patient knowledge encouraged deference. Today, armed with fragmented information from the internet, friends, and personal experience, some patients attempt to circumvent that expertise rather than engage with it. But medical autonomy is not the same as medical entitlement. Patients have every right to question recommendations or refuse treatment; they do not have an equivalent right to demand treatments that are unlikely to help and may harm others through antibiotic resistance.
Nor can physicians escape responsibility. Patients who feel unheard are more likely to misrepresent their symptoms. At the same time, physicians pressured to satisfy consumer expectations may find it easier to prescribe than explain why one is unnecessary. Trust requires effort on both sides.
The challenge is to restore a clinical relationship in which telling the truth is more valuable than telling the doctor what it takes to get a prescription.
Source: Symptom Misrepresentation to Obtain Antibiotics JAMA Network Open DOI: 10.1001/jamanetworkopen.2026.39559
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Chuck Dinerstein, MD, MBA
Director of Medicine
Charles Dinerstein, MD, MBA, is the Medical Director of the American Council on Science and Health. A vascular surgeon with more than 25 years of clinical experience, he brings a physician's understanding of medical decision-making, an appreciation for scientific uncertainty, and a broader perspective on healthcare economics and policy to his writing.
