Pressure on doctors to prescribe needs measuring directly

BMJ 1998;317:818 ( 19 September )

Letters

Pressure on doctors to prescribe needs measuring directly

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EDITOR $---$ Ramsden et al found that there was no relation between general practitioners' confidence in the pharmacological efficacyof their prescriptions and the patients' expectations for prescriptions.¹They concluded that doctors are not pressurised into giving prescriptionsthey do not believe are of benefit. This contradicts our results,which were based on a survey of consultations carried out in fourgeneral practices in south London.²

Whereas Ramsden et al used the patients' expectations as a proxy for doctors feeling pressurised, we measured both of thesevariables directly. We found a significant relation between patients'hopes for prescriptions and doctors feeling pressurised, doctorsbeing more likely to feel pressurised if the patients hoped forprescriptions (46/266 (17.3%) v 2/154 (1.3%), $chi$ ²=24.6, df=1, P<0.001). However, for over half of the consultationspatient expectations did not identify pressurised doctors, mainlybecause of the large number of cases for which the patient hoped. . . [Full text of this article]