You’re right: the Antibiotics-For-Every-Symptom patients are quite annoying.
My strategy is kinda flexible, depending on my perception of the patient’s I-IQ (Infection Intelligence Quotient). I have honed down my speech on “antibiotics don’t kill viruses” to about 30 seconds; with an extra 20-second-addendum of “these are the risks of antibiotics that I see every day: diarrhea, rashes, lingering stomach problems, resistance, thrush, vaginal yeast infections…” if the patient still doesn’t seem convinced.
Then, if they still insist, my closing sentence is:
I strongly feel that an antibiotic will not help your viral illness at this time, but I will give you a prescription for an antibiotic today, in case you develop a bacterial infection on top of this virus. On the back of the prescription, I’m writing down the symptoms that I would consider as “reasons to start taking the antibiotic” [obviously, these symptoms vary from case to case, but the list always includes ‘if your current symptoms do not get ANY better in 3-7 days’] — if I were you, I would wait a couple more days, because you may be just on the verge of getting over your viral illness.”
And that’s it! Sometimes I’ll modify my approach, and ask them to call me at the urgent care in 3-5 days if they still feel sick, so we can discuss an antibiotic Rx vs. recheck at that time. (Since after all, if they are getting worse, perhaps a doctor should re-examine them before just throwing medication at them!)
Also, a study found that referring to patient’s upper-respiratory-viral-infection diagnoses as “head colds" and "chest colds” (instead of “sinus infection” or “bronchitis”) helped patients to be more accepting of the viral etiology to their illness, and less likely to feel that they need an antibiotic. So I try to use those terms prominently when I discuss their diagnosis.
I knew a doctor who would be a bit more passive-aggressive than I am (I know, right? Hard to imagine.), and when the patient would demand antibiotics, would tell them “I don’t think it’s going to help you unless you are still sick in a week” — and then on the prescription, he’d write a “start date” of 1 week from now, so that when the patient would rush over to the pharmacy right away to get it filled, they’d be told, “This Rx isn’t good until next week." :)