Practice recommendations
- Messages about physician-patient communication found in prescription direct-to-consumer advertising (DTCA) uphold rather than undermine the physician’s control.
- Keep in mind that patients encouraged by DTCA to ask you about prescription drugs are not necessarily demanding prescriptions.
- Be sure to discuss with patients who inquire about advertised products their risks and side effects—topics largely ignored by print DTCA messages.
Abstract
Background Critics of DTCA contend it alters physician-patient communication by promoting greater patient participation and control. We assessed the nature of messages in print DTCA to identify potential guidelines they may provide to consumers for communicating with physicians.
Methods We analyzed all unique advertisements (ie, excluded ads repeated across issues or magazines) in 18 popular magazines (684 issues) from January 1998 to December 1999 (n=225). We identified every statement that referred to physicians, and within that set, statements that focused on physician-patient communication. Each communication-related statement was coded as a message to consumers about communication in terms of cues suggesting who should initiate communication, who should be in relational control, and appropriate interaction topic(s).
Results More than three-quarters (83.8%) of the advertisements’ statements referring to physicians focused on physician-patient communication (M=2.6 per ad; SD=1.8). Most (76.1%) of these messages explicitly or implicitly promoted consumers initiating communication, but cast the physician in relational control (54.5%). The most frequently suggested interaction topics were clinical judgments of the product’s appropriateness (41.8%) and information about the product (32.1%).
Conclusions Typical direct-to-consumer print ads contain multiple messages about communicating with physicians. The patterned nature of these messages appears to promote social norms for consumers’ communication behavior by repeatedly implying the appropriateness of consumers initiating interaction, physicians maintaining relational control, and avoiding negative consequences of advertised drugs as conversational topics.
Arecent medical journal debate focuses on effects of direct-to-consumer advertising of prescription drugs (DTCA) on the physician-patient relationship.1-11 Both sides contend that DTCA alters consumers’ communication behavior, and, ultimately, relationships with physicians, by encouraging greater patient participation and control. Increasingly, patients are asking physicians about advertised products and doctors do feel pressured to prescribe.12-20 Thus, research to date has indicated that social norms for physician-patient communication are changing, but has not accounted for DTCA’s features that focus directly on physician-patient communication. This study examines DTCA’s references to physician-patient communication that may imply guidelines for consumers’ interaction behavior.
Pro and con opinions. Opinions vary regarding DTCA’s effects on health care and public health.21 Critics disagree about DTCA’s effects on cost (including time),1-3,8,10,22-27 consumers’ knowledge,2,24-25 and health care quality.1,3,4,24-25 Advocates view DTCA as empowering patients to partner with physicians,4,24 initiate discussion,25 show interest, and ask questions.27,28 Opponents say DTCA undermines the relationship,2,24,29,30 by overloading physicians with time-consuming questions they are unprepared to answer,25,31 creating pressure to prescribe, and increasing patient demand that yields inappropriate prescribing.32
The issue centers on who should be “in charge.” Proponents tend to value patients’ empowerment;4,33 opponents generally advocate physicians’ authority.34 However, both sides agree that DTCA influences patients to communicate more actively and take greater control.
Ultimate goal of DTCA.Because obtaining prescription drugs requires physicians’ cooperation, DTCA’s aims differ from traditional advertising. Successful ads must both attract consumers to products and facilitate consumers gaining physicians’ cooperation. Even “sold” consumers may not have the communication skills to interact appropriately and persuasively with physicians. Thus, to succeed commercially, DTCA must encourage particular consumer communication behaviors.
Establishing who is in control. Physician-patient relationships are developed and maintained largely via communication patterns. Communication patterns associated with physician-patient relationship models differ, largely, in terms of relational control.35,36 Relational control, accomplished through communication, “refers to the process of establishing [who has] the right to direct, delimit, and define the actions of the dyad,” in this case, the physician-patient relationship.37
Paternalism36 casts the physician in control of information and decisions, and the patient as expected to cooperate.38
Participatory models35 reflect a partnership with relatively equal power evident in mutual information sharing and exploration of alternatives.38
Consumerism places control in patients’ hands; consumers may bargain and engage actively in communication, but theoretically they control final decisions and may demand particular treatment regimens.36
Are DTCAs “training” consumers? Previous content analyses of DTCA focus on marketing factors (eg, ad frequency, product type)39,40 and on appeals, motivators, or inducements for consumers,39-41 but do not address DTCA’s statements about physician-patient communication.42 When social cognitive theory is applied to DTCA, it suggests that DTCA may “train” consumers by providing models or examples from which to learn vicariously, while associating those models with positive outcomes or rewards, and the advertised drug, thus motivating consumers to seek the product.43 Thus, DTCA may encourage specific communication behaviors as the means to acquire advertised products. If so, its influence may lie less in its educational function than in its social training function.