Table 5 Categories and quotations for the theme “External influencing factors”

Patient-related aspects

“Yes, you should never experiment with patients … or expose them to risk of injury. It is very important. This is why I think that we GPs are very careful with new drugs. I prefer to wait a while with a new drug before I prescribe it …”

“You might think so, but the patient may think differently …”

“ … I think it is very important not to give in, at least in those cases with tetracycline versus penicillin, it feels important to explain to the patient the risk of bacterial resistance and so on … so there you can compromise a bit on the patient-doctor relationship …”

Drug industry-related aspects

“A conflict arises sometimes. Some patients are so well-read and influenced by the media and sometimes want another drug and … insist …”

“We don’t know anything about that. We don’t know if somebody there is on Pfizer’s board … or is biased …”

“… and then you think about how life was before the [local] guidelines even existed. … we were drug industry indoc … formed … (laughs)”

Health economic aspects

“…I think that it is OK to save money on things you can save money on … maybe to be able to do more tests of that kind or something else … the budget is not unlimited, so I usually think that this is not a problem.”

“… but there is a lot of focus on economy here, more focus on economy than on the pharmacological benefit compared to other drugs … so from that point of view it is highly controlled …”

“I am not really sure if the economy part motivates us …”

“The goal is to save money, I suppose, and more and more of the drug costs are transferred to the primary health care centres … so of course it matters …”