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Uncomfortable prescribing decisions: a critical incident study
1Department of General Practice, University of Manchester, Rusholme Health Centre.
BMJ (Clinical Research Ed.)
|February 1, 1992
Summary
General practitioners experience discomfort when prescribing, often due to patient expectations and concerns about drug toxicity. Complex medical, social, and logistic factors influence these prescribing decisions.
Area of Science:
- General Practice
- Medical Decision-Making
- Pharmaceutical Science
Background:
- Prescribing decisions in general practice are complex.
- Understanding physician discomfort is crucial for improving prescribing practices.
Purpose of the Study:
- To investigate the discomfort experienced by general practitioners (GPs) concerning prescribing decisions.
- To identify factors contributing to prescribing discomfort in primary care.
Main Methods:
- Qualitative study using focused interviews with 74 general practitioners.
- Critical incident technique employed to analyze prescribing decisions causing discomfort.
Main Results:
- Discomfort was frequently associated with antibiotics, tranquillisers, hypnotics, and symptomatic remedies for respiratory diseases, musculoskeletal problems, and anxiety.
- Reasons for prescribing decisions included patient expectations, clinical appropriateness, doctor-patient relationship dynamics, and precedents.
- Reasons for discomfort involved concerns about drug toxicity, personal expectations, treatment appropriateness, and uncertainty.
Conclusions:
- Prescribing decisions are influenced by a multifaceted interplay of medical, social, and logistical considerations.
- The final prescribing action results from a complex interaction of these diverse influences in general practice.