Table 1:

Vignettes

Parent Vignette 1a: Typical Risks and Benefits	Maria is four and has had a cold for the last week. For the last two nights she has woken up several times crying and complaining about her ear. This morning she has a fever. Her mother took her to the doctor who explained that Maria started out with a common cold but now might have a mild bacterial ear infection. The doctors tells her that we used to treat all ear infections with antibiotics. However, new guidelines say that in a kid Maria’s age it is okay to consider waiting a few days to see if the infection goes away on its own. The doctor and Maria’s mom discuss whether to start antibiotics to treat the ear infection. The doctor tells her that antibiotics sometimes shorten the course of illness—making it a little more likely the ear infection and pain will be gone within a week. They also decrease the chance of minor complications from the infection. The doctor tells Maria’s mom that about a quarter of kids who take antibiotics for an ear infection get diarrhea, a rash or vomiting and a few develop an allergic reaction. While they are talking, Maria’s mom remembers that she recently read a newspaper article that talked about how some bacteria are becoming resistant to common antibiotics.
Physician Vignette 1b:	Maria is a previously healthy two year old who has had a cold for about a week. For the last two nights she has woken up several times crying and complaining about her ear. Her mom reports that she had a fever last night. In your office she is well-appearing but a little clingy. She is afebrile. Her exam is normal except for clear rhinorrhea and an inflamed right ear drum that is full but not bulging. It has purulent fluid visible behind it.
Parent Vignette 2: Risk of Obesity	So, now, let’s imagine that Maria’s doctor tells Maria’s mom that a new scientific study has come out that suggests young children who get antibiotics for minor infections, such as ear infections, have an increased chance of being obese in kindergarten or overweight in kindergarten.