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11/12/2001

Physicians Succumb to Patients' Pressure to Prescribe

Kate Traynor

A new study suggests that patients find subtle and overt ways to persuade physicians to prescribe unnecessary antimicrobials for the treatment of respiratory illnesses.

According to a report in the October Journal of Family Practice, a third of the patients who visited their family practice physician because of symptoms of an acute respiratory-tract infection described that illness as unusually severe or implied a need for help in getting well. For 80 percent of these patients, the physician responded by prescribing unnecessary antimicrobial therapy, the researchers determined.

A smaller proportion of patients—13 percent—told their physician that an antimicrobial they had used in the past had worked well to treat a similar illness. In 97 percent of these cases, the researchers found, the physician prescribed an unnecessary antimicrobial for the new illness.

The three-year study focused on 298 outpatient visits made to 18 community-based family practices in Nebraska. Field researchers directly observed and recorded data on the patient–physician encounters. Afterward, the researchers determined whether the decision to prescribe an antimicrobial was made in accordance with guidelines from the Centers for Disease Control and Prevention (CDC).

Physicians who participated in the study prescribed an antimicrobial during 68 percent of the observed visits. Eighty percent of these prescriptions, the researchers determined, did not conform to CDC’s antimicrobial-use criteria.

Physicians appeared sympathetic to patients who said they needed to be well by a certain time so that they could attend an important event. Nearly 90 percent of the time, the physicians inappropriately prescribed an antimicrobial to such patients, who represented 6 percent of the study's participants.

During 6 percent of the visits described in the study, patients explicitly asked the physician to prescribe an antimicrobial drug. In 93 percent of these cases, the physician granted the request.

Potentially manipulative patient behaviors that did not significantly influence prescribing included emphasis of the symptoms suggestive of a bacterial infection and offering of a "candidate diagnosis" to the physician. The researchers described only one type of patient behavior—description of symptoms with no embellishment—as not putting pressure on a physician to prescribe an antimicrobial.

Children under 16 years of age, who accounted for 36 percent of the observed visits, were significantly less likely than adults to receive a prescription for an inappropriate antimicrobial therapy.