General practitioners’ attitudes towards acute benign affections: with or without drugs?

Summary Aim: General practitioners often have to take care of patients with acute benign affections which would naturally heal themselves. Nevertheless drug prescriptions remain substantial. Our aim was to analyze their logic in prescribing drugs. Methods: This qualitative study was conducted in 2011 in Saint-étienne among 11 GPs. Results: Physicians swayed between two logics. The first one targeted curing with drugs which are sometimes impure placebos (their use being justified by their harmlessness and their effectiveness). Prescribing was a way of maintaining the patients’ trust in their authority. The medico-economic criticism against those drugs, i.d. the end of reimbursement and the new guidelines, were being ignored. The second logic was one of reduction in drug prescription: reassuring and counselling becoming thus a way of curing. Impure placebos were being criticized because of their secondary effects and the dishonesty and dependency they implied. Guidelines were thus a help to deal with the patients. Conclusion: Two models may be opposed. The first one is empiric: relations between GPs and patients are strengthened thanks to positive experiences. The second one is based on a factual model which aims at determining the clinical utility of the treatment. The risk-and-cost-to-benefit ratio is compared to that of therapeutic alternatives. This questions the physician’s role in the treatment of these acute benign affections. To help in the medical decision, there is a need for a critical discussion on drug prescription, on the way society looks at the role of doctors and on the organization of the health care system. Prat Organ Soins. 2012;43(2):111-119