Prescribing decisions in general practice--learning and changing.

The key to changing the prescribing behaviour of doctors is to understand the decision-making processes underlying their prescribing. Prescribing decisions have been described as a two-stage process. The first stage is to consider a range of possible treatment options and the second stage is to make a selection from among these. A large number of non-pharmacological influences have been identified as operating between the first and second stage. These emanate chiefly from influences being brought to bear on the process by patients, doctors other than the prescriber, the pharmaceutical industry and from the funders of health care. Doctors need to acquire a range of new knowledge and skills to deal with these pressures to prescribe. Among these are skills in negotiating with patients; an appreciation of the realities of decision making in primary (as opposed to secondary) care; skills in the critical appraisal of drug company claims and dealing with the marketing skills of pharmaceutical company sales representatives; and knowledge of and skills in health economics to deal with the concerns of health care funders. In addition, new ways of working with these and other interested parties need to be evolved and certain decisions may be more appropriately considered and taken in situations other than face to face with patients.