Evidence that Patients Exert Comparatively Irresistible Influence on Physicians Prescribing

Using a survey of 211 patients, Keitz et al. (2007) determined patient pre-visit expectations for meds, tests, and specialist referrals, post-visit fulfillment of expectations, and the effects on satisfaction and trust. They found:

• • Overall: 66% of patient expectations were met.
• • Physicians suggested alternatives 21.6% of the time.
• • Expectations met for meds, 75%.
• • Expectations met for tests, 71%.
• • Expectations met for referrals, 40%.

Of 138 physicians, 62 (44.9%) reported that they would not have ordered for meds, referrals, and tests had the patients not directly asked and acquiescing to eight requests (12.9%) made them uncomfortable. The study concluded that patients generally received what they asked for and altered physician behavior nearly half of the time. Patient satisfaction and trust were unchanged regardless of whether or not expectations were met.

It will be objected that direct-to-consumer (DTC) advertising prompts patients’ requests for meds, tests, and referrals, which physicians, who are increasingly subject to patient satisfaction surveys, find irresistible (at least when compared with drug rep detailing). Were patients more ignorant of their options, ex ante, they might make fewer focused requests for their physicians. Thus, banning DTC has been proposed. I leave that proposal aside.