A new study published in the Apr. 2014 issue of the journal Medical Care highlights a troubling reality of today’s health care landscape: Too often, doctors prescribe potentially dangerous medications to patients who shouldn’t be getting them, and what they prescribe is influenced by the pills patients ask for.
The study found that patient requests for certain medications — such as the powerful narcotic oxycodone — “substantially affected physician-prescribing decisions, despite the drawbacks of the requested medications.”
The results suggested that even a gentle request from a patient could convince a doctor to prescribe potent, potentially dangerous narcotics — even when they’re not the best-practice treatment for the patient’s condition.
To determine whether patients could influence their doctors’ prescribing practices, 192 primary care physicians from six states viewed videos in which professional actors simulated a consultation with a primary care doctor. The actors described symptoms that suggest sciatica, or back and leg pain that could be caused by nerve damage.
Half of the “patients” asked for oxycodone specifically, and the other half didn’t. The wording of the patients’ request for oxycodone was rather unnerving. They said: “My wife/husband had some oxycodone left over from some dental surgery and I took one last night and … I mean, it really worked. I was amazed.”
One video scenario depicted a truck driver complaining of pain. Narcotics aren’t recommended for people who have occupations that rely heavily on driving.
Painkillers such as oxycodone also aren’t recommended for newly presenting cases of sciatica, which is what was shown in the videos.
After viewing the video scenarios, the doctors were asked how they would manage the case and what medication they would prescribe.
About 20% of the sciatica patients who requested oxycodone got it. Of the sciatica patients in the study who didn’t ask for oxycodone, only 1% received a prescription for it.
Even when the doctors didn’t prescribe oxycodone in particular, they were more likely to prescribe another strong narcotic to patients who had requested oxycodone. The doctors prescribed either oxycodone or another strong narcotic (like percocet) to 73% of the patients who requested oxycodone and to only 30% of the patients who didn’t.
‘An enormous red flag’
While some patients with severe pain may legitimately require the strongest available treatments, the study shows just how easy it can be for others to get a prescription for unneeded medication.
The idea that patients’ suggestions could influence doctors to prescribe things against their best judgment is especially troubling considering the recent spike in pain pill abuse. States have also been cracking down on pill mills that hand out narcotic painkillers to people who don’t have a medical need for them.
Physician and Duke behavioural scientist Peter Ubel, who wrote a book about how patients can work with their doctors to make medical decisions, told Business Insider that this shows a problem with medical training.
“That should have been an enormous red flag,” Ubel said. “If a patient you’ve never seen before comes to you with a common complaint like back pain and asks for a specific narcotic drug, there should be sirens going off.”
Still, the results of the study could be partially attributed simply to the power of suggestion, Ubel said.
“Once you mention anything to someone, that is in their brain now,” he said. “It could be that you’re trying to make a decision and then all of a sudden someone mentions something and you can’t think of another thing … but you should overcome it when it’s an inappropriate suggestion.”
The study also included actor-patients who requested the drug Celebrex for their osteoarthritis. This group of “patients” — claiming to have seen ads for the anti-inflammatory drug — saw similar results: 53% of those who asked for Celebrex received it, compared to only 24% of the patients who didn’t make a specific request for the drug.
Together, the findings suggest that some doctors are easily swayed by patients — even when prescribing narcotics that are prone to abuse — and that pharmaceutical advertisements targeted at patients may actually affect what doctors prescribe.
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