Objective: This study investigates the relationship of ‘online commentary’(contemporaneous physician comments about physical examination [PE] findings) with (i) parent questioning of the treatment recommendation and (ii) inappropriate antibiotic prescribing. Methods: A nested cross-sectional study of 522 encounters motivated by upper respiratory symptoms in 27 California pediatric practices (38 pediatricians). Physicians completed a post-visit survey regarding physical examination findings, diagnosis, treatment, and whether they perceived the parent as expecting an antibiotic. Taped encounters were coded for ‘problem’ online commentary (PE findings discussed as significant or clearly abnormal) and ‘no problem’ online commentary (PE findings discussed reassuringly as normal or insignificant). Results: Online commentary during the PE occurred in 73% of visits with viral diagnoses (n = 261). Compared to similar cases with ‘no problem’ online commentary, ‘problem’ comments were associated with a 13% greater probability of parents uestioning a non-antibiotic treatment plan (95% CI 0-26%, p = .05,) and a 27% (95% CI: 2-52%, p < .05) greater probability of an inappropriate antibiotic prescription. Conclusion: With viral illnesses, problematic online comments are associated with more pediatrician-parent conflict over non-antibiotic treatment recommendations. This may increase inappropriate antibiotic prescribing. Practice implications: In viral cases, physicians should consider avoiding the use of problematic online commentary

NSTIs are a rare but significant diseases in children. It seems that, as in the adult population, prompt surgical debridement is the most important intervention. Corticosteroid therapy may be associated with a worse prognosis.

Objective. To examine the simultaneous associations of parent and coder assessments of communication events with parent satisfaction. Study Setting. Five hundred twenty-two pediatrician-patient encounters. Study Design. Parents reported on post-visit satisfaction with care and whether four communication events occurred. Raters also coded communication events from videotapes. Multivariate analyses predicted parent satisfaction. Principal Findings. Satisfaction was greater when parents perceived at least three communication events. Parent and coder reports were nearly uncorrelated. Coder-assessed communication events not perceived by parents were unrelated to parent satisfaction. Conclusions. Parents are more satisfied when most or all of the expected parentphysician communications occur. A successful pediatrician-parent communication event is one that a parent recognizes as having occurred; it is not merely one that a trained observer says occurred.

Communication-based interventions may improve experiences and ratings of care for all subgroups, although implementation of these interventions may need to consider preferences associated with race, ethnicity, and language.