Patient pressure may be stronger in the doctor's mind than in the patient's

Although patients' expectations of general practice consultations influence outcomes, they are not as influential as doctors' assessments. This may sound obvious except for the fact that doctors' assessments of patients' preferences have more influence than those preferences themselves. In this issue Little et al are publishing two studies.1 2 Their observational study generalises the finding from an earlierstudy3 that doctors' perceptions are a stronger predictor of their actions—from prescribing to other consultation activities—than are patients' expectations. The same factors (including doctors' perceptions) affecting prescribing decisions also affect other clinical decisions. This makes it all the more important that doctors' perceptions are accurate. Inappropriate assessments of patients' expectations can result in actions deemed unnecessary by the doctor and unwanted by the patient.

In their interventional study Little et al used leaflets and found that most of the increased investigations resulting from the intervention were …