title: Factors affecting physicians' responses to patients' requests for antidepressants: focus group study.
abstract: BACKGROUND
  The ways in which patients' requests for antidepressants affect physicians' prescribing behavior are poorly understood.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Focus group interviews and brief demographic questionnaires.
  
  
  METHODS
  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.
  
  
  METHODS
  Iterative review of interview transcripts, involving qualitative coding and thematic analysis.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rochester Center to Improve Communication in Health Care, Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Aleksey_Tentler@urmc.rochester.edu
authors.forename: Aleksey
authors.initials: A
authors.lastname: Tentler
authors.forename: Jordan
authors.initials: J
authors.lastname: Silberman
authors.forename: Debora A
authors.initials: DA
authors.lastname: Paterniti
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
mesh_terms: D000329:Advertising; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D017144:Focus Groups; D006801:Humans; D010358:Patient Participation; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians'
chemical_list: D000928:Antidepressive Agents