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General Practice

Misunderstandings in prescribing decisions in general practice: qualitative study

BMJ 2000; 320 doi: (Published 19 February 2000) Cite this as: BMJ 2000;320:484
  1. Nicky Britten, director of concordance unit (nicky.britten{at},
  2. Fiona A Stevenson, research fellowb,
  3. Christine A Barrya,
  4. Nick Barber, professorc,
  5. Colin P Bradleyd
  1. a Guy's, King's, and St Thomas's Department of General Practice and Primary Care, King's College, London SE11 6SP
  2. b Department of General Practice, University of Birmingham B15 2TT
  3. c School of Pharmacy, University of London, London WC1N 1AX
  4. d Department of General Practice, University College Cork, Republic of Ireland
  1. :N Britten
  • Accepted 29 November 1999


Objectives: To identify and describe misunderstandings between patients and doctors associated with prescribing decisions in general practice.

Design: Qualitative study.

Setting: 20 general practices in the West Midlands and south east England.

Participants: 20 general practitioners and 35 consulting patients.

Main outcome measures: Misunderstandings between patients and doctors that have potential or actual adverse consequences for taking medicine.

Results: 14 categories of misunderstanding were identified relating to patient information unknown to the doctor, doctor information unknown to the patient, conflicting information, disagreement about attribution of side effects, failure of communication about doctor's decision, and relationship factors. All the misunderstandings were associated with lack of patients' participation in the consultation in terms of the voicing of expectations and preferences or the voicing of responses to doctors' decisions and actions. They were all associated with potential or actual adverse outcomes such as non-adherence to treatment. Many were based on inaccurate guesses and assumptions. In particular doctors seemed unaware of the relevance of patients' ideas about medicines for successful prescribing.

Conclusions: Patients' participation in the consultation and the adverse consequences of lack of participation are important. The authors are developing an educational intervention that builds on these findings.


  • Funding The study on which this paper is based is funded by the Department of Health as part of the prescribing research initiative. The views expressed in this paper are those of the authors and not the Department of Health.

  • Competing interests None declared.

  • website extra A table showing the categories of misunderstandings for each patient appears on the BMJ's website

  • Accepted 29 November 1999
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