Can Doctors Tell Patients No? It's Not Easy

Between the Internet and drug ads, patients these days have some pretty firm ideas about what they want to get out of a visit with the doctor.

Around 10 percent of the time patients ask doctors for medicine, and the docs usually go along with the request. Sometimes that's a good medical idea, but often doctors just do what the patient wants.

Why? It's hard for doctors to say no. A big reason is that they don't want patients to be dissatisfied. Think parents who want antibiotics for their screaming kids' ear infections, even though the evidence says that's usually not the hottest idea.

Some researchers looked at the problem in a nifty study that sent actors to the offices of more than 150 primary care doctors in search of antidepressants. The results appear in the current issue of the Archives of Internal Medicine.

Some of the fake patients were trained to act as though they had major depression with pain in the wrist. The others were trained to present with symptoms of adjustment disorder with back pain, a tougher call for meds. Most of the patients asked for drugs, sometimes by brand name.

All the actors were middle-aged white women. They surreptitiously recorded the visits, which were later reviewed by the researchers. The doctors had agreed to be part of a study and knew some fake patients would be coming to see them, but they didn't know the patients' identities or the exact thrust of the project.

What was the upshot? When patients asked for meds, they got them 56 percent of the time.

What about when they didn't? Doctors tried different strategies, ranging from outright rejection in a few cases to an in-depth conversation on the context for the patient's request. Those discussions led to reports of higher satisfaction from the fake patients.

Of course, chats like those take time, something in shorter supply than prescription pads in most primary care offices.



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