Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners

In this study of the influences affecting general practitioners' decisions whether or not to prescribe, 69 principals and five trainees in general practice were asked about the factors that made these decisions difficult for them and the circumstances in which the decision caused them to feel uncomfortable. Discomfort was reported most frequently in prescribing for respiratory disease, psychiatric conditions and skin problems, though the range of problems mentioned was wide. The range of drugs for which the decision of whether or not to prescribe was difficult was also wide but psychotropic drugs, antibiotics, drugs acting on the cardiovascular system and non-steroidal anti-inflammatory drugs were most often mentioned. Patient factors said to be important included age, ethnicity, social class and education, the doctor's prior knowledge of the patient, the doctor's feeling towards the patient, communication problems, and the doctor's desire to try to preserve the doctor-patient relationship. Doctor specific factors included concerns about drugs, factors relating to doctors' role perception and expectations of themselves, uncertainty, peer influences, logistic factors, and the experience of medical or therapeutic misadventures. The results of this study support earlier work on the influence of social factors on prescribing decisions and show that this influence affects the entire range of clinical problems. The results also reveal the importance of logistic factors. The overriding concern of doctors to preserve the doctor-patient relationship and the range of attitudes, perceptions and experiences of doctors that have a bearing on the decision to prescribe begin to explain the apparent irrationality of some general practitioner prescribing.(ABSTRACT TRUNCATED AT 250 WORDS)