From feeling ignored by doctors to believing antibiotics are the only answer, new research reveals why some patients bend the truth to get prescriptions, and what this could mean for antibiotic resistance.
Study: Symptom Misrepresentation to Obtain Antibiotics. Image credit: DC Studio/Shutterstock.com
A recent study in the journal JAMA Network Open reports that in a survey of US adults, nearly 28% said they had at some point misrepresented their symptoms to clinicians to obtain antibiotics. Lower awareness of antibiotic risks and the dangers of antimicrobial resistance were associated with higher odds of such misrepresentation.
Misleading symptoms can undermine responsible antibiotic use
Outpatient care accounts for most antibiotic use in the United States, with about 255.9 million prescriptions issued each year. Unnecessary prescribing exposes patients to adverse effects, allergic reactions, and Clostridioides difficile infection, and it accelerates antimicrobial resistance.
Clinicians decide whether antibiotics are warranted partly on the basis of what patients tell them about symptom onset, severity and duration. As a result, these decisions may be influenced by inaccurate reporting.
Earlier research has shown that patients sometimes knowingly withhold or alter information, but little is known about the prevalence of deliberate misrepresentation of symptoms by US adults specifically to obtain antibiotics. In this study, the authors aimed to estimate its prevalence, identify the reasons given, and associated patient characteristics.
Survey examined symptom exaggeration, fabrication and underlying motivations
The investigators performed an online survey of US adults between January 8 and February 13, 2026. Participants were recruited through the market research firm Dynata. This was a nonprobability sample, with quotas set for age, gender, race and ethnicity, and census region. Of 1,371 eligible respondents who began the survey, 959 were in the final analysis.
The authors measured two behaviors: exaggeration and fabrication. Exaggeration was defined as knowingly overstating the severity or duration of real symptoms, while fabrication meant reporting non-existent symptoms.
Respondents who reported engaging in either behavior answered follow-up questions about the symptoms involved, their success in obtaining antibiotics, and their reasons. Those who denied performing both behaviors answered further questions about the underlying reasons. All respondents completed measures of antibiotic knowledge and beliefs, comorbidities, acceptability of lying, health literacy, and subjective numeracy.
The authors fitted an exploratory multiple logistic regression model to identify characteristics associated with reported symptom misrepresentation.
Nearly 28% admitted misrepresenting symptoms to obtain antibiotics
The mean age was 50.7 years, with a nearly even split between male and female respondents. Overall, 268 respondents reported having ever misrepresented symptoms to a clinician to obtain antibiotics. Of these, 108 only exaggerated, 19 only fabricated, and 141 did both.
Among those who misrepresented symptoms, 206 said they had obtained antibiotics this way at least once, and 85 said they had done so more than once. About two-thirds were at least moderately confident that the approach would work.
Cold-like symptoms such as fever, cough and sore throat were most commonly misrepresented, followed by stomach symptoms and joint or muscle pain. Respondents mainly learned what to say from their own experience, friends or family, and clinicians. They also named social media and AI chatbots as sources.
Misconceptions about antibiotics were common among those who misrepresented symptoms. Of the 268 respondents, 108 believed there was no downside to taking antibiotics, while 86 did not believe antibiotic resistance was real.
Despite these beliefs, 121 respondents identified someone, usually a medical professional or family member, whose advice could persuade them not to misrepresent symptoms in the future. Regret was less common, however. Just 77 regretted misrepresenting their symptoms, often citing adverse effects, a lack of benefit, or the feeling that their actions were wrong. Of these, 52 also regretted taking the antibiotics.
Fears and personal responsibilities drove symptom misrepresentation
Respondents who misrepresented symptoms cited four broad groups of reasons. The first related to illness severity, with 167 reporting feeling very sick, 144 worrying about a serious infection, and 139 experiencing prolonged illness. The second reflected beliefs about antibiotic effectiveness, with 166 believing antibiotics were the only treatment that would help them recover.
The third reason was the pressure to resume everyday responsibilities, with 163 wanting to return to work or parenting duties sooner and 153 concerned about infecting others. The fourth centered on personal autonomy, with 145 believing they understood their own medical needs better than their clinician and 133 feeling they should decide which treatments they needed. A further 111 wanted antibiotics to keep for future use.
In contrast, respondents who had never misrepresented symptoms overwhelmingly valued honest communication with clinicians to ensure appropriate treatment. Most also trusted their clinician's judgment and considered lying about symptoms morally wrong.
Better antibiotic knowledge was associated with lower odds
The exploratory regression model found that younger respondents were more likely to report misrepresenting symptoms, with those aged 18–33 and 34–55 having approximately three times the odds compared with those aged 65 and older.
The odds were also more than twice as high among respondents who felt clinicians did not take their symptoms seriously or believed antibiotic resistance was a hoax. Those who needed help reading health materials had similarly elevated odds. Having more existing health conditions and viewing lying as more acceptable were also associated with greater odds of misrepresentation.
In contrast, respondents with greater knowledge about antibiotics or a stronger dislike of taking them had lower odds of misrepresenting symptoms. No statistically significant associations were found with sex, race or ethnicity.
Better communication could help address antibiotic-seeking misrepresentation
According to the authors, these findings suggest that symptom misrepresentation may reflect problems in patient-clinician relationships, rather than simply individual dishonesty. Patients who feel clinicians do not hear them may exaggerate symptoms to ensure their concerns are addressed. The authors suggest this could occur when clinicians downplay symptoms to temper expectations of receiving antibiotics.
The authors also highlight conspiracy-related beliefs about antibiotic resistance, including claims that it was created to increase pharmaceutical profits, as another factor associated with mistrust in healthcare. This points to the need for clear, consistent public messaging. Notably, these findings come from an exploratory study and require validation.
The association with comorbidity may reflect a greater sense of vulnerability to infection.
Some factors, such as attitudes that excuse lying in order to get what is needed, may be difficult to change. Others, including antibiotic knowledge and patient-clinician communication, could potentially be addressed through targeted interventions.
Nonrepresentative survey limits conclusions about wider US population
The nonprobability online sample is not fully representative of the US population, so the authors characterize their estimates as preliminary and hypothesis-generating. Self-report is subject to social desirability bias, potentially leading to underestimation.
The survey asked about lifetime behavior, which could have introduced recall error. The survey did not capture how often misrepresentation occurred, to what degree, or by what strategies, and some motives were not measured directly. For example, some respondents wrote that they sought antibiotics for uninsured relatives.
Because the analysis is cross-sectional and exploratory, none of the associations establish causation.
Symptom misrepresentation raises concerns for responsible antibiotic prescribing
Nearly 30% of respondents reported ever misrepresenting symptoms to obtain antibiotics, most often cold-like symptoms, and most of those had reportedly succeeded at least once. The authors conclude that this is a significant concern for prescribers, antimicrobial stewardship, and public health.
They call for better antibiotic education and improved patient-clinician communication strategies. These could help build stronger trust between them and address patient concerns.
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