Misunderstandings in prescribing decisions in general practice: qualitative study

doi:10.1136/bmj.320.7233.484

BMJ 2000;320:484-488 ( 19 February )

General Practice

Misunderstandings in prescribing decisions in general practice: qualitative study

Nicky Britten, director of concordance unit, ^a Fiona A Stevenson, research fellow, ^b Christine A Barry, research fellow, ^a Nick Barber, professor, ^c Colin P Bradley, professor. ^d

^a Guy's, King's, and St Thomas's Department of General Practice and Primary Care, King's College, London SE11 6SP, ^b Department of General Practice, University of Birmingham B15 2TT, ^c School of Pharmacy, University of London, London WC1N 1AX, ^d Department of General Practice, University College Cork, Republic of Ireland

Correspondence to: N Britten nicky.britten{at}kcl.ac.uk

Objectives: To identify and describe misunderstandingsbetween patients and doctors associated with prescribing decisionsin generalpractice.
Design: Qualitativestudy.
Setting: 20 general practices in the West Midlandsand south eastEngland.
Participants: 20 general practitioners and 35 consultingpatients.
Main outcome measures: Misunderstandings between patients and doctorsthat have potential or actual adverse consequences for takingmedicine.
Results: 14 categories of misunderstanding were identifiedrelating to patient information unknown to the doctor, doctorinformation unknown to the patient, conflicting information, disagreementabout attribution of side effects, failure of communication aboutdoctor's decision, and relationship factors. All the misunderstandingswere associated with lack of patients' participation in the consultationin terms of the voicing of expectations and preferences or thevoicing of responses to doctors' decisions and actions. They wereall associated with potential or actual adverse outcomes suchas non-adherence to treatment. Many were based on inaccurate guessesand assumptions. In particular doctors seemed unaware of the relevanceof patients' ideas about medicines for successfulprescribing.
Conclusions: Patients' participation in the consultationand the adverse consequences of lack of participation are important.The authors are developing an educational intervention that buildson thesefindings.

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Rapid Responses:

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Patients' attributions often do not match doctors' explanations: Andrew Thornett
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