title: The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics--A Study of Medical Ethics Using Immersive Virtual Reality.
abstract: BACKGROUND
  Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner's daily routine. This study explores the extent to which portable Immersive Virtual Reality technology can help us gain an accurate understanding of the factors that influence a doctor's response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide). It also considers the potential of such technology to train doctors to face such dilemmas.
  
  
  METHODS
  Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously.
  
  
  RESULTS
  Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants' level of presence (together with participants' feedback and body language) suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening.
authors.affiliation: Institute of Cognitive Neuroscience, University College London, London, United Kingdom.|Department of Computing, Goldsmiths College, University of London, London, United Kingdom.
authors.forename: Xueni
authors.initials: X
authors.lastname: Pan
authors.affiliation: Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain.|Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.|Department of Computer Science, University College London, London, United Kingdom.
authors.forename: Mel
authors.initials: M
authors.lastname: Slater
authors.affiliation: Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Beacco
authors.affiliation: Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
authors.forename: Xavi
authors.initials: X
authors.lastname: Navarro
authors.affiliation: Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
authors.forename: Anna I
authors.initials: AI
authors.lastname: Bellido Rivas
authors.affiliation: Department of Computer Science, University College London, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Swapp
authors.affiliation: Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
authors.forename: Joanna
authors.initials: J
authors.lastname: Hale
authors.affiliation: Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
authors.forename: Paul Alexander George
authors.initials: PA
authors.lastname: Forbes
authors.affiliation: UCL Faculty of Laws, University College London, London, United Kingdom.
authors.forename: Catrina
authors.initials: C
authors.lastname: Denvir
authors.affiliation: Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
authors.forename: Antonia F de C
authors.initials: AF
authors.lastname: Hamilton
authors.affiliation: UCL Faculty of Laws, University College London, London, United Kingdom.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Delacroix
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001499:Bayes Theorem; D004992:Ethics, Medical / Q000193:education*; D005260:Female; D058005:General Practitioners / Q000941:ethics* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations / Q000941:ethics*; D010818:Practice Patterns, Physicians' / Q000941:ethics* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000941:ethics; D000066908:Simulation Training / Q000379:methods; D011795:Surveys and Questionnaires; D063367:Virtual Reality Exposure Therapy / Q000193:education*
chemical_list: D000900:Anti-Bacterial Agents