Researchers in Liverpool interviewed a small group of family doctors, nurses, and lay people to explore their views on the minimum benefit they thought would justify drug treatment to prevent heart attacks.

Participants varied widely in the minimum acceptable benefits chosen. Many disliked the concept of taking pills every day and preferred lifestyle change to medication.

Participants wished to consider adverse effects and costs of treatment. They also wanted to make decisions for themselves, and clinicians supported this.

There is a danger that increased pressure on general practitioners to prescribe some drugs may distort practice and marginalise patients' preferences, say the authors. They believe that guidelines should reflect the importance of true dialogue between clinicians and patients before embarking on lifelong preventive treatment.

True dialogue between patient and doctor is essential, and patients' preference and values must be respected, adds Robert Johnstone in an accompanying commentary. He recommends that greater emphasis be placed on listening skills in doctor training and that more opportunities for "expert patient" training be provided.

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Contact: Emma Dickinson
edickinson@bmj.com
44-20-7383-6529
BMJ-British Medical Journal
9-Oct-2003