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Objective To analyse the frequency of adverse events to treatment reported by patients in relation to consultation time, attention from their usual doctor and information provided by their doctor about treatment. Design Descriptive study. Patients were invited to respond to a telephone survey. Setting 21 Primary Care health centres in Spain. Participants 15 282 patients attended by GPs or paediatricians (error of 1% for p¼q¼0.50, a 95%) were selected at random from the total consultations recorded in 1 month. For sampling, quotas were assigned for type of attention, age and sex. In the case of children (under 14 years), the survey was answered by their parents. Main outcome measures Patients' report on frequency of unexpected or adverse reaction to a treatment; whether informed or not about possible complications of the treatment and precautions to take; consultation time; and whether or not patient is usually seen by the same doctor.Results 1557 (17.6%, CI 95% 16.8 to 18.4%) of the adults and 867 (13.7%, 95% CI 12.8 to 14.5%) of the children reported adverse or unexpected reactions to the treatment according to patients' reports. Consultation time (OR 0.5, 95% CI 0.4 to 0.5), doctor rotation at the health centre (OR 2.04, 95% CI 1.85 to 2.25) and information on treatment precautions (OR 0.47, 95% CI 0.43 to 0.53) determine the higher risk of adverse reactions to treatment. Conclusions Planning at health centres should involve the monitoring of mean consultation time and doctor rotation as indirect indicators of safety. Furthermore, protocols related to the information provided to patients should be reviewed.

ObjectivesIdentify the sources of overuse from the point of view of the Spanish primary care professionals, and analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals face these demands.DesignA cross-sectional study.SettingPrimary care in Spain.ParticipantsA non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was recruited during the survey.Primary and secondary outcome measuresThe frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.ResultsIn all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments that patients could find on printed and digital media, contributed to the professional’s inability to adequately counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x2=88.8, P<0.001, percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x2=175.7, P<0.001, PD=12.3).ConclusionSatisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.

Most persons registering a living will are healthy individuals with a particular religious faith who reject certain treatments. Most health professionals do not check whether critically ill patients have made a living will. Exercising the rights contained in living wills is complicated by the diversity of criteria among different regions.

Low-value and potentially dangerous practices were identified; avoiding these could improve care quality.