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Doctors Have Many Ways to Say 'No'
Date:2/22/2010

Consideration of patient's needs and beliefs helps preserve relationship, study finds

MONDAY, Feb. 22 (HealthDay News) -- When a patient asks for a treatment that a physician doesn't believe will work, savvy doctors say no very, very carefully.

Television advertising of prescription medicines leads many patients to request drugs that may be inappropriate for them. And new research finds that taking into account the patient's needs and desires is the most effective way for a physician to say "no," said Debora A. Paterniti, associate adjunct professor of internal medicine and sociology at the University of California, Davis, and lead author of a report in the Feb. 22 issue of the Archives of Internal Medicine.

She and her colleagues looked at 199 visits to primary-care doctors in which the patient requested an antidepressant -- the kind of request that doctors are familiar with because of direct advertising to consumers and word-of-mouth advice from friends and relatives, Paterniti said.

Eight-eight of those requests were denied, but in only five of those cases was the denial a simple "no."

Six approaches were used to explain why the prescription wouldn't be written. "Each of those strategies might reach different sorts of patients in different ways," Paterniti said.

In 53 cases, the doctors emphasized the patient's perspective. They asked where information about the drug came from and why they thought it might be helpful; recommended seeing a counselor or mental health specialist; or said something other than depression might be the source of the problem.

In 26 visits, the doctors took biomedical approaches, such as prescribing sleeping aids instead of antidepressants or ordering a diagnostic workup to detect problems such as thyroid disease or anemia.

"Physicians have a more nuanced strategy for dealing with patients than they did before," Paterniti said.

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