Herbert Menzel

Social processes in physicians' adoption of a new drug

Abstract Two hundred and sixteen physicians in four cities were interviewed, and the prescription records of 125 general practitioners, internists, and pediatricians among them were searched, in order to study how the use of a new drug termed “gammanym” spread through these communities of physicians. The main findings are: 1. 1. Gammanym was introduced earlier by doctors with a large volume of prescriptions for this general type of drug, by those who exposed themselves frequently to certain media of information, and by those who shared their offices with one or several partners. 2. 2. Doctors who maintained a variety of contacts with a large number of colleagues, the socially integrated doctors, typically introduced the new drug into their practices months before their relatively isolated colleagues. The degree of a doctors integration was measured by the number of his colleagues who named him, in response to certain interview questions, as an advisor, frequent discussion partner, or frequently visited friend. 3. 3. Among the integrated doctors, the use of the new drug spread at an accelerating rate, indicating an interpersonal process of diffusion, while among the isolated doctors use of the new drug spread at a constant rate, indicating largely individual responses to constant stimuli outside the community of doctors. 4. 4. The hypothesis that a doctor and his friend, a doctor and his advisor, and a doctor and his discussion partner would tend to introduce the new drug at about the same time was not borne out for the period as a whole. 5. 5. During the early months following the drugs release, however, doctors who introduced the drug tended to follow closely upon any associates who had adopted it earlier. 6. 6. This phenomenon was strongest during the very earliest months in the case of pairs of discussion partners and advisor-advisee pairs. In the case of pairs of friends, it reached its peak about 2 months later. In all three cases, the phenomenon occurred among the relatively isolated doctors as well as among the integrated doctors, but it reached its peak much later in the case of the isolated doctors. 7. 7. The apparent greater effectiveness of contacts with colleagues during the early months was attributed to the greater uncertainty about the new drug that prevailed at that time. This interpretation is supported by comparisons of uncertain and clear-cut situations of another sort; pairs of related doctors were found to be more alike in the drugs they use for essential hypertension than in the drugs they use for respiratory infections. A second article will inquire into the possible relationship of early gammanym introduction by a doctor to a more general tendency to be receptive to innovations.

Dimensions of being “Modern” in medical practice

I N ORDER to learn something of the way in which medical innovations make their way into the doctor’s practice, intensive interviews were conducted with 216 physicians in four midwestern cities, and their replies were subjected to statistical analysis. A previous article’ described how the use of a new medication spread gradually among most of the 125 general practitioners, pediatricians, and internists among them. (This was ascertained by examining pharmacists’ prescription records covering a 16-month peri0d.t) This account constitutes a case history of the diffusion of a single innovation, a relatively minor variant of a well-established family of drugs. One cannot presume that the findings presented so far would necessarily hold true for innovations of other kinds or under other conditions. One wonders, nevertheless, whether the doctors who were first to use this particular drug would again be first the next time a new drug is introduced and whether they are progressive in other respects as well. This is an intriguing question; for, on the one hand most doctors know that they evaluate each proposed innovation on its own merits and, on the other hand, one keeps hearing some doctors described as “quick to jump on the bandwagon ,” or as “individuals that try everything that comes along,” while others are characterized as “stodgy doctors” who “are not interested in hearing about new techniques and want things to go on as they are.” Are such descriptions mere caricatures, or is there really some generalized tendency or trait of “innovatingness” which is strong in some doctors and weak or absent in others? This article is designed to answer this question, to the extent that an answer is possible on the basis of the data gathered. We will first look into the timing of the introduction of new drugs into the individual physician’s practice and then into other aspects of the use of modern drugs. Later we will turn to some broader questions of modern practice.