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Doctors’ Responses to Patient Drug Requests

By January 9, 2013Commentary

While spending growth on prescription drugs has dropped dramatically, a significant amount of money is still spent on this category each year.  Over the last decade, demand, especially for brand-name drugs, has been driven not only by marketing to physicians but increasingly by direct-to-consumer advertising, the intent of which is to encourage patients to ask their doctor to prescribe the drug for them.  To the extent that doctors are reluctant to turn patients down, and research shows that many have that reluctance, the effect may be to encourage prescribing that is not really necessary and that adds to overall expenditures.  A new study, based on a survey of physicians, published in the Archives of Internal Medicine examines characteristics of doctors in regard to their responses to patient requests for a drug.    (Arch. Int. Med.)

The respondents comprised about 1900 doctors in seven specialties.  Interestingly, 43% of doctors in practice for 10 years or more gave in to patient requests sometimes or often compared to only 31% in practice for less than ten years.  Internal medicine physicians were less likely to acquiesce than cardiologists, surgeons, pediatricians and anesthesiologists.  Physicians in small solo or two person practices were much more likely to comply with a patient request than those employed by a hospital or medical school.  Doctors who met frequently with industry reps, who got free samples or who got free food or beverages were also more likely to comply with requests.   While it is difficult to say that the additional prescribing by compliant doctors is inappropriate, it seems unlikely that it is all necessary.  Doctors need to be trained in how to tactfully turn down patient requests for any treatment when they believe it really is not necessary.

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