Patients' demands for prescriptions in primary care

Patients cannot take all the blame for overprescribing

The Audit Commission's recent report on prescribing in general practice in England and Wales estimated that up to pounds sterling275m could be saved from the NHS drugs bill if overprescribing was reduced.1 The report lists several overprescribed drugs, including antibiotics and non-steroidal anti-inflammatory drugs. The authors clearly believe that patients' expectations of treatment are partly responsible for the problem, as do many general practitioners.2 Perhaps the most memorable view came from Marinker, who said, “We may see the doctor as helpless in the face of a population of patients who have an overwhelming need to alter chemically their experiences of the world in which they live.”3 He compared a general practitioner in a consulting room to a barmaid in a gin shop, implying that not only do patients know exactly what they want but that they usually get it. But what evidence is there that patients' demands for prescriptions have any effect on doctors' prescribing habits other than prompting repeat prescribing?

Much of the …