Factors Affecting Physicians’ Responses to Patients’ Requests for Antidepressants: Focus Group Study
The ways in which patients’ requests for antidepressants affect physicians’ prescribing behavior are poorly understood.
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.
Focus group interviews and brief demographic questionnaires.
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.
Iterative review of interview transcripts, involving qualitative coding and thematic analysis.
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.
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 WORDSpatient requests antidepressants antidepressive agents doctor-patient communication patient-physician relationship depression advertising focus groups primary care physicians
- 8.Weissman JS, Blumenthal D, Silk AJ, et al. Physicians report on patient encounters involving direct-to-consumer-advertising. Health Aff (Millwood). 2004;Suppl Web Exclusives:W4-219–33.Google Scholar
- 11.Young HN, Paterniti DA, Bell RA, Kravitz RL. Do prescription drug advertisements educate the public? The consumer answers. Drug Inf J. 2005;39:25–33.Google Scholar
- 14.Mintzes B, Barer ML, Kravitz RL, et al. How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. Can Med Assoc J. 2003;169(5):405–12.Google Scholar
- 16.Glazer BG, Strauss A. The Discovery of Grounded Theory. New York: Aldine; 1967.Google Scholar
- 18.Morgan DL, Krueger RA. The Focus Group Kit. Beverly Hills: Sage; 1998.Google Scholar
- 21.Kaplan SH, Greenfield S, Ware JE, Jr. Impact of the doctor–patient relationship on the outcomes of chronic disease. In: Stewart M, Roter D, eds. Communicating with Patients in Medical Practice. Beverly Hills: Sage; 1989b:228–45.Google Scholar
- 22.Roter DL. Patient participation in the patient–provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Educ Monogr. 1997;5:281–315.Google Scholar
- 27.Damasio AR. Descartes’ Error: Emotion, Reason, and the Human Brain. New York: Putnam; 1994.Google Scholar
- 28.Damasio AR. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt Brace Jovanovich; 1999.Google Scholar
- 29.Dreyfus HL. On the Internet (Thinking in Action). New York: Routledge; 2001.Google Scholar
- 39.Wilson TD, Centerbar DB, Brekke N. Mental contamination and the debiasing problem. In: Gilovich T, Griffin D, Kahneman D, eds. Heuristics and Biases: The Psychology of Intuitive Judgment. New York, NY: Cambridge; 2002:185–200.Google Scholar