The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics--A Study of Medical Ethics Using Immersive Virtual Reality

Abstract

Background: Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner's daily routine. This study explores the extent to which portable Immersive Virtual Reality technology can help us gain an accurate understanding of the factors that influence a doctor's response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide). It also considers the potential of such technology to train doctors to face such dilemmas.

Experiment: Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously.

Results: Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants' level of presence (together with participants' feedback and body language) suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening.

Fig 1. The physical setup and virtual scenario.

(A) The participant wearing the head-mounted display and seated at the real desk that was registered with the virtual desk in virtual reality. (B) An overview of the scenario—the participant occupied the doctor position behind the desk. The medical student was seated to the right of the participant and the patient on the other side of the desk to the left, with her daughter to the right. (C) The patient and her daughter in conversation with the participant (D) the medical student.

Fig 2. Box plot of Place Illusion and Plausibility by Experience.

The thick horizontal black lines are the medians, and the boxes are the interquartile ranges.

Fig 3. Posterior distributions of p by Experience, compared to the prior distribution that p has a uniform distribution on [0,1].

Fig 4. Scatter plots of estimated probability of prescription by place illusion and plausibility.