Doctors’ Prescriptions: a Shared Responsibility?

Is the act of issuing a prescription the culmination of a complex chain of decisions?

Two thirds of consultations with general practitioners end with the issuing of a prescription. The decision to prescribe is influenced by many factors, to do with the doctor, the patient, the doctor-patient interaction, and the wider social context, including the effects of advertising and the financial incentives and disincentives for all parties. Hardline advocates of rational drug use do not look kindly on variations in prescribing patterns that cannot be explained by purely clinical factors. The prescriber who allows the “Friday night penicillin” phenomenon to sway his or her clinical judgment tends to do so surreptitiously and with a guilty conscience.

But such behaviour is the rule rather than the exception. Several studies have shown that the prescribing behaviour of doctors is heavily influenced by their perceptions of the social background, beliefs, attitudes, and expectations of the patient, as well as the uncertainty of the diagnosis.

continue reading Pressure to prescribe, The BMJ,, 06 December 1997.

The image shows the Distilbène drug prescribed in 1972, despite in 1971 the FDA declared DES was contraindicated for use in pregnancy. DES continued to be prescribed in France until 1977

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