Prescribing analgesics: the effect of patient age and physician specialty

To determine if patient age or physician specialty influences the willingness to prescribe pain medication, a mail survey was made of all emergency physicians, family practice physicians, and pediatricians listed as practicing in a single, middle sized, urban county in the southwest. The survey instrument presented a typical case of otitis media complicated only by pain so severe that the patient had been unable to sleep. Physicians were asked specifically if they would prescribe an analgesic and if so what kind. Emergency and family practice physicians were presented on a random basis with cases that were identical except the age was given at two or 22 years old. Pediatricians were given only the two year old. Eighty percent (137/165) of the surveys were completed and returned. Only 28% of the physicians would prescribe medications stronger than acetaminophen or nonsteroidal antiinflammatory drugs. There was a trend toward more narcotic analgesics for the 22 year old (41 vs 22% Fisher's exact test P = 0.03). Emergency physicians were the most generous, prescribing narcotics (codeine or oxycodone compounds) half the time (50%) versus one quarter of the time (22%) for family practice physicians and pediatricians (Fisher's exact test, P < 0.01). Pediatricians and family practice physicians did not differ (20 vs. 25%, P = 0.8). Potent analgesics are rarely prescribed by our sample physicians. Children are somewhat less likely to receive narcotics than adults with the same complaint. Emergency physicians are more likely to prescribe potent analgesics than are family practice physicians or pediatricians.