Tentler Aleksey, Silberman Jordan, Paterniti Debora A, Kravitz Richard L, Epstein Ronald M
Rochester Center to Improve Communication in Health Care, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Gen Intern Med. 2008 Jan;23(1):51-7. doi: 10.1007/s11606-007-0441-8. Epub 2007 Nov 7.
The ways in which patients' requests for antidepressants affect physicians' prescribing behavior are poorly understood.
To describe physicians' affective and cognitive responses to standardized patients' (SPs) requests for antidepressants, as well as the attitudinal and contextual factors influencing prescribing behavior.
Focus group interviews and brief demographic questionnaires.
Twenty-two primary care physicians in 6 focus groups; all had participated in a prior RCT of the influence of patients' requests on physicians' prescribing.
Iterative review of interview transcripts, involving qualitative coding and thematic analysis.
Physicians participating in the focus groups were frequently unaware of and denied the degree to which their thinking was biased by patient requests, but were able to recognize such biases after facilitated reflection. Common affective responses included annoyance and empathy. Common cognitive reactions resulted in further diagnostic inquiry or in acquiescing to the patient's demands to save time or build the patient-clinician relationship. Patients' requests for medication prompted the participants to err on the side of overtreating versus careful review of clinical indications. Lack of time and participants' attitudes--toward the role of the patient and the pharmaceutical ads--also influenced their responses, prompting them to interpret patient requests as diagnostic clues or opportunities for efficiency.
This study provides a taxonomy of affective and cognitive responses to patients' requests for medications and the underlying attitudes and contextual factors influencing them. Improved capacity for moment-to-moment self-awareness during clinical reasoning processes may increase the appropriateness of prescribing.
患者对抗抑郁药的需求影响医生开药行为的方式尚不清楚。
描述医生对标准化患者（SPs）对抗抑郁药需求的情感和认知反应，以及影响开药行为的态度和背景因素。
焦点小组访谈和简短的人口统计学问卷。
6个焦点小组中的22名初级保健医生；他们都曾参与过一项关于患者需求对医生开药影响的随机对照试验。
对访谈记录进行反复审查，包括定性编码和主题分析。
参与焦点小组的医生常常没有意识到且否认患者需求对其思维的影响程度，但在引导性反思后能够认识到这种偏见。常见的情感反应包括恼怒和同理心。常见的认知反应导致进一步的诊断询问，或为节省时间或建立医患关系而默认患者的要求。患者对药物的需求促使参与者倾向于过度治疗而非仔细审查临床指征。时间不足以及参与者对患者角色和药品广告的态度也影响了他们的反应，促使他们将患者的需求解读为诊断线索或提高效率的机会。
本研究提供了对患者药物需求的情感和认知反应的分类，以及影响这些反应的潜在态度和背景因素。在临床推理过程中提高即时自我意识的能力可能会提高开药的合理性。
