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Healthy Skepticism Library item: 18029

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Cockburn J, Pit S.
Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations--a questionnaire study.
BMJ 1997 Aug 30; 315:(7107):520-3
http://www.bmj.com/cgi/content/full/315/7107/520?view=long&pmid=9329308


Abstract:

OBJECTIVES: To examine the effect of patients’ expectations for medication and doctors’ perceptions of patients’ expectations on prescribing when patients present with new conditions. DESIGN: Questionnaire study of practitioners and patients. SETTING: General practice in Newcastle, Australia. SUBJECTS: 22 non-randomly selected general practitioners and 336 of their patients with a newly diagnosed medical condition. MAIN OUTCOME MEASURES: Prescription of medication and expectation of it. RESULTS: Medication was prescribed for 169 (50%) patients. After controlling for the presenting condition, patients who expected medication were nearly three times more likely to receive medication (odds ratio = 2.9, 95% confidence interval 1.3 to 6.3). When the general practitioner thought the patient expected medication the patient was 10 times more likely to receive it (odds ratio = 10.1, 5.3 to 19.6). A significant association existed between patients’ expectation and doctors’ perception of patients’ expectation (chi 2 = 52.0, df = 4, P = 0.001). For all categories of patient expectation, however, patients were more likely to receive medication when the practitioner judged the patient to want medication than when the practitioner ascribed no expectation to the patient. CONCLUSIONS: Although patients brought expectations to the consultation regarding medication, the doctors’ opinions about their expectations were the strongest determinants of prescribing.

Keywords:
* Adolescent * Adult * Age Factors * Aged * Attitude of Health Personnel * Australia * Drug Prescriptions * Drug Utilization/statistics & numerical data* * Family Practice* * Female * Humans * Male * Middle Aged * Patient Satisfaction * Perception * Physician's Practice Patterns * Physician-Patient Relations* * Sex Factors

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909