Editorials

Pressure to prescribe

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7121.1482 (Published 06 December 1997) Cite this as: BMJ 1997;315:1482

Involves a complex interplay of factors>

  1. Trisha Greenhalgh, Senior lecturer (p.greenhalgh@ucl.ac.uk)a,
  2. Paramjit Gill, Senior lecturera
  1. a Department of Primary Care and Population Sciences, UCLMS/RFHSM, Whittington Hospital, London N19 5NF

    Two thirds of consultations with general practitioners end with the issuing of a prescription.1 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.2 3 4 5 6 Hardline advocates of rational drug use do not look kindly on variations in prescribing patterns that cannot be explained by purely clinical factors.1 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,2 as well as the uncertainty of the diagnosis.5 7

    Bradley identified several patient factors associated with doctors' discomfort when prescribing (or refusing to prescribe) drugs: extremes …

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