Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2008 Jan;23(1):51-7.
doi: 10.1007/s11606-007-0441-8. Epub 2007 Nov 7.

Factors affecting physicians' responses to patients' requests for antidepressants: focus group study

Aleksey Tentler  1 , Jordan Silberman, Debora A Paterniti, Richard L Kravitz, Ronald M Epstein
Affiliations
Randomized Controlled Trial

Factors affecting physicians' responses to patients' requests for antidepressants: focus group study

Aleksey Tentler et al. J Gen Intern Med. 2008 Jan.

Abstract

Background: The ways in which patients' requests for antidepressants affect physicians' prescribing behavior are poorly understood.

Objective: To describe physicians' affective and cognitive responses to standardized patients' (SPs) requests for antidepressants, as well as the attitudinal and contextual factors influencing prescribing behavior.

Design: Focus group interviews and brief demographic questionnaires.

Participants: Twenty-two primary care physicians in 6 focus groups; all had participated in a prior RCT of the influence of patients' requests on physicians' prescribing.

Measurements: Iterative review of interview transcripts, involving qualitative coding and thematic analysis.

Results: Physicians participating in the focus groups were frequently unaware of and denied the degree to which their thinking was biased by patient requests, but were able to recognize such biases after facilitated reflection. Common affective responses included annoyance and empathy. Common cognitive reactions resulted in further diagnostic inquiry or in acquiescing to the patient's demands to save time or build the patient-clinician relationship. Patients' requests for medication prompted the participants to err on the side of overtreating versus careful review of clinical indications. Lack of time and participants' attitudes--toward the role of the patient and the pharmaceutical ads--also influenced their responses, prompting them to interpret patient requests as diagnostic clues or opportunities for efficiency.

Conclusions: This study provides a taxonomy of affective and cognitive responses to patients' requests for medications and the underlying attitudes and contextual factors influencing them. Improved capacity for moment-to-moment self-awareness during clinical reasoning processes may increase the appropriateness of prescribing.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Influence of patients’ requests on physicians’ prescribing.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.293.16.2030', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.293.16.2030'}, {'type': 'PubMed', 'value': '15855439', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15855439/'}]}
    2. Hollon M. Direct to consumer advertising: a haphazard approach to health promotion. JAMA. 2005;293:2030–3. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.281.4.380', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.281.4.380'}, {'type': 'PubMed', 'value': '9929095', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9929095/'}]}
    2. Holmer AF. Direct-to-consumer prescription drug advertising builds bridges between patient and physicians. JAMA. 1999;281:380–2. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '9420585', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9420585/'}]}
    2. Lipsky MS, Taylor CA. The opinions and experiences of family physicians regarding direct-to-consumer advertising. J Fam Pract. 1997;45:495–9. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '11813459', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11813459/'}]}
    2. Young D. Studies show drug ads influence prescription decisions, drug costs. Am J Health Syst Pharm. 2002;59:14, 16. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1371/journal.pmed.0030145', 'is_inner': False, 'url': 'https://doi.org/10.1371/journal.pmed.0030145'}, {'type': 'PMC', 'value': 'PMC1420390', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1420390/'}, {'type': 'PubMed', 'value': '16563041', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16563041/'}]}
    2. Almasi EA, Stafford RS, Kravitz RL, Mansfield PR. What are the public health effects of direct-to-consumer drug advertising? PLoS Med. 2006;3:e145. - PMC - PubMed

Publication types

Substances