Prescribing and referral in general practice: a study of patients' expectations and doctors' actions

What decisions do patients expect the general practitioner to take within the consultation and to what extent are these expectations fulfilled? What factors influence patients' expectations and general practitioners' actions?

This study aimed to examine these questions with reference to prescribing and hospital referral.

The study covered 1080 consultations with 12 general practitioners in two north London practices. Information was collected by self-administered questionnaires from patients before the consultation and from the general practitioners after the consultation.

Fifty one per cent of patients expected and 55% received a prescription; 13% expected hospital referral and 10% were referred. Factors related to their presenting problem were most strongly associated with patients' expectation of receiving a prescription. The actions which the general practitioners took were most strongly associated with patients' expectations. Patients' anxiety about their health problem also appeared to influence their expectations of referral and the doctor's prescribing decision.

This study suggests that patients' expectation of management and their anxiety associated with the presenting problem may be two of the factors which influence general practitioners' prescribing and referral behaviour and may explain some of the observed variations in behaviour.