Antibiotics can kick many ailments, but they don’t fight everything—like anything caused by a virus, such as the flu, and most colds. Taking antibiotics for such problems is not only useless, it’s what helps microbes develop resistance to the drugs, which in turn leads to difficult-to-treat, often-deadly infections.

Yet doctors face a daily dilemma: to be good doctors, they must only prescribe antibiotics when the drugs are needed. But to make patients think they’re good doctors, they must hand out antibiotics freely—at least according to a new nationwide healthcare survey in England.

The survey, which included nearly a million patients and 7,800 practices, found that patients were least satisfied with family doctors who were frugal with antibiotic prescriptions. In fact, the amount of antibiotic prescriptions a practice doled out was a leading predictor of its patient satisfaction ranking. The finding, published in the British Journal of General Practice, suggests that responsible use of antibiotics for the greater good may mean doctors take a hit in their patient popularity.

During the study period from 2012 to 2013, the practices issued 33.7 million antibiotic prescriptions to a patient population of 53.8 million. Using the trend data from the survey, the researchers calculated that a clinic’s patient satisfaction score could fall by up to 6 percentile points in national rankings if doctors cut back antibiotic prescriptions by 25 percent.

Health experts estimate that up to 50 percent of antibiotic prescriptions are given inappropriately, mostly when they’re unneeded or improperly dosed. An earlier survey found that 51 percent of people with a simple cough or cold got an antibiotic. Other surveys found that more than 55 percent of doctors felt pressured to give antibiotics, even when they knew the drugs would be unhelpful. In fact, 44 percent of doctors surveyed admitted they had prescribed antibiotics just to get a patient to leave their office.

British Journal of General Practice, 2015. DOI: 10.3399/bjgp15X688105 (About DOIs).