THE INFLUENCE OF PATIENTS HOPES OF RECEIVING A PRESCRIPTION ON DOCTORS PERCEPTIONS AND THE DECISION TO PRESCRIBE - A QUESTIONNAIRE SURVEY

Objectives: To measure patients' expectations of receiving prescriptio ns and general practitioners' perceptions of these expectations and to determine the factors most closely associated with the decision to pr escribe. Design: Questionnaires were completed by patients waiting to see their general practitioners, and by their doctors immediately afte r the consultations. Setting: Four non-fundholding group practices in southeast London. Subjects: 544 unselected patients consulting 15 gene ral practitioners. Main outcome measures: Doctors' perceptions of pati ents' expectations; doctors' decisions to prescribe. Results: 67% (354 /526) of patients hoped for a prescription; doctors perceived that 56% (305/542) of patients wanted prescriptions; and doctors wrote prescri ptions in 59% (321/543) of consultations. Despite the close-agreement between patients' hopes and doctors' perceptions, 25% (89/353) of pati ents hoped for a prescription but did not receive one. In 22% (68/313) of consultations in which prescriptions were written, they were not s trictly indicated on purely medical grounds, and in only 66% (202/306) of consultations in which prescriptions were written were they both i ndicated and hoped for. Doctors' perceptions of patients' expectations were the strongest predictor of the decision to prescribe, but the fi nal regression model also included patients' hopes and ethnic group, a nd the doctor's feeling of being pressurised. Conclusions:In an area o flow prescribing and high expectations the decision to prescribe was c losely related to actual and perceived expectations, but the latter wa s the more significant influence.