PRESCRIBING BEHAVIOR IN CLINICAL-PRACTICE - PATIENTS EXPECTATIONS ANDDOCTORS PERCEPTIONS OF PATIENTS EXPECTATIONS - A QUESTIONNAIRE STUDY

Objectives: To examine the effect of patients' expectations for medica tion and doctors' perceptions of patients' expectations on prescribing when patients present with new conditions. Design: Questionnaire stud y of practitioners and patients. Setting: General practice in Newcastl e, Australia. Subjects: 22 non-randomly selected general practitioners and 336 of their patients with a newly diagnosed medical condition. M ain outcome measures: Prescription of medication and expectation of it . Results: Medication was prescribed for 169 (50%) patients, After con trolling for the presenting condition, patients who expected medicatio n were nearly three times more likely to receive medication (odds rati o = 2.9, 95% confidence interval 1.3 to 6.3). When the general practit ioner thought the patient expected medication the patient was 10 times more likely to receive it (odds ratio = 10.1, 5.3 to 19.6). A signifi cant association existed between patients' expectation and doctors' pe rception of patients' expectation (chi(2) = 52.0, df = 4, P = 0.001). For all categories of patient expectation, however, patients were more likely to receive medication when the practitioner judged the patient to want medication than when the practitioner ascribed no expectation to the patient. Conclusions: Although patients brought expectations t o the consultation regarding medication, the doctors' opinions about t heir expectations were the strongest determinants of prescribing.