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A new study published in the April 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.
The study
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 either, 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 or hydrocodone) 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.