Drug expectations and drug choices of hospital physicians

Abstract

Choosing less desirable drugs is not always related to having too high expectations of the drug. Assigning a different importance to certain aspects of the drug and resorting to decision strategies that do not include the weighing of all pros and cons provide alternative explanations for such treatment choices.

Factors Determining Prescribing Decisions in a Teaching Hospital Setting

“…7 • 8 Applying this theory, Denig and colleagues surveyed prescribers in a Dutch hospital to evaluate prescribers' expectations regarding aspects of drug therapy, and how this related to prescribing decisions. 9 They focused on biomedical aspects including: efficacy, side effects, convenience of use, costs, anticipated approval of colleagues, patient wishes, and personal experiences. The results were not consistent for all treatment areas surveyed and the authors concluded that less desirable drug therapy choices are not always related to prescribers having inflated expectations of the drug.…”

“…As well, there may be discrepancy between what prescribers say or think they do and what they do in actual practice. 9 However, there is some reassurance given that in the case of the pneumonia scenario, the preference for ceftriaxone overall and the greater preference for ceftriaxone at Hospital B compared with Hospital A, reflects measured drug usage patterns. 4 • 12 The survey tool we developed is new and requires further testing for reproducibility and utility in different clinical situations with different factors.…”

Do medical students copy the drug treatment choices of their teachers or do they think for themselves?

“…After the participants had made their treatment choice, they were given a list of drug choice-related factors (see below) that are mentioned in the literature as contributing to therapeutic decision-making [5, 6, 8–11]. The participants were asked to indicate to what extent each of the 14 factors had contributed to the choice of treatment for each patient case (0 = to no extent at all, 1 = to some extent, 2 = to a considerable extent, 3 = to a decisive extent).…”

La compréhension de l'antibiothérapie chez des étudiants et des étudiantes en médecine : Enjeux didactiques et sociaux

“…Diverses pistes (inspirées de Lave, 1988) peuvent être proposées : mises en situation, jeux de rôles pour permettre aux apprenants d'envisager les concepts selon différentes perspectives, travail en équipe dans le but d'envisager différents points de vue, liens avec la pratique envisagée. En ce sens, Denig et al (1993) suggèrent d'utiliser l'approche développée par l'Organisation Mondiale de la Santé : « Ce programme est constitué d'approches de résolution de problème permettant de confronter ce que font les étudiants avec ce qu'ils pensent qu'ils font» (p. 162, traduction libre). De plus, ils suggèrent de favoriser les discussions entre les nouveaux médecins et leurs collègues plus expérimen-tés puisque la prescription est grandement influencée par l'expérience et les attentes d'un praticien.…”