Journal of General Internal Medicine

, Volume 23, Issue 1, pp 51–57 | Cite as

Factors Affecting Physicians’ Responses to Patients’ Requests for Antidepressants: Focus Group Study

  • Aleksey Tentler
  • Jordan Silberman
  • Debora A. Paterniti
  • Richard L. Kravitz
  • Ronald M. Epstein
Original Article

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.

KEY WORDS

patient requests antidepressants antidepressive agents doctor-patient communication patient-physician relationship depression advertising focus groups primary care physicians 

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Aleksey Tentler
    • 1
  • Jordan Silberman
    • 1
  • Debora A. Paterniti
    • 3
    • 4
  • Richard L. Kravitz
    • 3
  • Ronald M. Epstein
    • 1
    • 2
  1. 1.Rochester Center to Improve Communication in Health Care, Department of Family MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Department of Psychiatry and OncologyUniversity of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Center for Health Services Research in Primary Care, Department of Internal MedicineUniversity of California, DavisSacramentoUSA
  4. 4.Department of SociologyUniversity of California, DavisSacramentoUSA

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