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Minerva Psichiatrica 2005 December;46(4):249-60

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: Italian

The effects of the doctor-patient relationship on drug prescription: a critical analysis

Bellino S., Zizza M., Paradiso E., Panaia R., Bogetto F.

The doctor-patient relationship plays a significant role when a drug therapy is prescribed. This role is conditioned by many factors related to characteristics and reactions to illness of the patient, care-givers and the family. In this paper, different types of the doctor-patient relationship are reviewed, particularly referring to the models proposed by Von Gebsattel, Schneider and Kaplan. A series of psychic factors that have noticeable effects on drug prescription, course and outcome of treatment have been focused on: placebo effect, which is the aspecific therapeutic effect due to psychological mechanisms; compliance to treatment, that indicates patient's adherence to doctor's prescriptions; pharmacophobia, or phobic refusal of drugs, and pharmacophilia, or excessive request for drugs. As for psychiatric interventions, other relevant factors concern complex interactions that take place in treatments combining pharmacotherapy and psychotherapy. All these factors are conditioned by the quality of the doctor-patient relationship and, on the other hand, produce effects that modify therapeutic interactions. These considerations imply the need for a specific training of physicians, who should achieve an adequate consciousness of these interpersonal dynamics and their effects on treatment outcome. In this framework, the program of seminars on the doctor-patient relationship that is currently provided to medical students of the University of Turin is described.