Case study: How Patient Requests Drive Prescribing Behavior

A 2025 systematic review published in Patient Education and Counseling analyzed over three decades of research to answer a controversial question: Do doctors prescribe medication just because patients ask for it?

The answer is a resounding yes. Across 118 studies involving thousands of interactions, researchers found that patient requests are a primary driver of prescribing behavior—regardless of the medical condition. While patient empowerment is a goal of modern medicine, this dynamic often leads to over prescription, particularly with antibiotics and opioids, or unnecessary brand-name dispensing when generics would suffice.

For pharmaceutical and medical device companies, this signals a critical shift. The traditional model of educating doctors on clinical data is no longer enough. To ensure appropriate product use and adherence, companies must coordinate education that helps patients ask the right questions and equips physicians to handle those conversations effectively.

This case study was originally published on Science Direct.

The Challenge

Why is the "gatekeeper" model failing in the digital age?

For decades, the physician acted as the sole gatekeeper of medical treatment. However, the rise of the internet, Direct-to-Consumer Advertising (DTCA), and the cultural shift toward "patient-centered care" have fundamentally altered the exam room dynamic. Patients now arrive with specific demands, turning the consultation into a negotiation.

The systematic review highlighted several friction points that lead to suboptimal prescribing:

• The pressure to please: Doctors often perceive a patient's request as a demand. To maintain the relationship or avoid a bad review, they grant the prescription, even if their clinical judgment suggests otherwise.
• Asymmetry of information: Patients often base requests on incomplete information found online, while doctors struggle to correct these misconceptions without seeming dismissive.
• Misinterpretation of intent: The study found that physicians frequently overestimate patient expectations. They often prescribe medication assuming the patient wants it, even when the patient was merely asking for reassurance.
  

The Solution

Replacing "requests" with Shared Decision-Making (SDM)

The review concludes that the solution isn't to silence patients, but to restructure the communication framework. The most successful outcomes occurred when the interaction moved from a transactional request to a Shared Decision-Making (SDM) model.

This requires a dual-pronged educational approach:

For the Physician (The Negotiator)

Physicians need more than clinical facts; they need communication strategies. The review suggests training doctors to:

• Decode the request: Identify if a patient is asking for a cure (the drug) or symptom relief (which might not require the drug).
• Validate and redirect: Acknowledge the patient's discomfort while explaining why a specific requested drug (like an antibiotic or brand-name opioid) isn't the right tool, preserving trust without yielding to pressure.
  

‍For the Patient (The Partner)

Medical companies have an opportunity to reshape patient education. Instead of marketing that encourages demands ("Ask your doctor for X"), effective programs focus on:

• Expectation management: Teaching patients what realistic recovery looks like so they don't demand quick fixes that carry long-term risks.
• Structured inquiry: Encouraging patients to ask "What are my options?" rather than "Can I have this specific pill?"

The Results

Alignment leads to better healthcare outcomes

When communication is managed correctly, the tension between patient empowerment and medical expertise dissolves. The systematic review found that addressing the communicative aspect of requesting led to clearer distinct outcomes:

• Reduced overprescription: When doctors felt empowered to explain their reasoning, unnecessary prescriptions for antibiotics and opioids decreased.
• Higher trust levels: Patients who felt heard, even if they didn't get the specific drug they requested, reported higher satisfaction than those who received a script without a discussion.
• Cost efficiency: Better communication facilitated the use of generic alternatives over expensive brand-name requests, reducing the burden on the healthcare system.
• Clinical adherence: Patients who understood why a decision was made were more likely to follow the agreed-upon treatment plan.

Next steps

• Guide: Understanding Coursera’s 2025 Learner Outcomes Report (how to measure outcomes, not vanity completions)
• Study: The Pharmacy Knowledge Gap Costing Pharma Millions (why trust + education beats “more clinical data”)
• Book your demo to see how Qurioos can help you coordinate your patient and HCP education strategies.