1 2 To achieve improved quality and safety of medicine use, a number of physician-oriented interventions are being delivered internationally in an attempt to improve evidence based prescribing in routine daily practice of medical practitioners—e.g., distribution of educational materials, decision support systems, outreach visits, medication reviews, etc. 3 4 5 6 7 7 8 7 7 9 10 Psychological reactance 10 11 10 10 10 12 13 13 14 15 15 15 16 17 Psychological reactance and physician-oriented interventions The long history of successful support for reactance theory in diverse settings and areas of behaviour may also have implications for physician-oriented interventions in which evidence based clinical recommendations are provided, as health care providers may not be immune to the phenomenon of psychological reactance. It is true that the basic concepts of psychological reactance are universal and likely also to be applicable to the provision of evidence based clinical recommendations to physicians. 10 14 It is also important to recognise that even in circumstances where physicians agree to participate in interventions, they may not necessarily expect their practice to be challenged. For example, there are several possible reasons for a physicians agreeing to a medication review. In some cases, physicians may wish to monitor the individual patient’s self-medication habits or they may be concerned about possible patient non-compliance with the medication regimen. 18 18 19 Possible determinants of reactance 20 20 21 10 10 11 22 23 25 26 27 28 29 29 19 Dealing with reactance A phenomenon like psychological reactance, which is likely to impede the desired outcome of physician-oriented interventions, needs to be adequately addressed when training healthcare professionals to deliver such interventions. We must be mindful that the process of delivering physician-oriented interventions can be difficult as psychological reactance is not a reasonable or rational response; it can cause people to become highly emotional and motivated to defend their behaviour. 22 We are now training pharmacists on how to deal with psychological reaction in the context of medication review. We also expect such training to enhance commitment to the pharmacy lead intervention from the interventionist’s perspective, as after being equipped with tools for dealing with reactance, pharmacists may experience a greater sense of self-efficacy in dealing with all types of physicians, including those who are highly reactant. In addition, awareness of reactant responses and its causes may assist pharmacists and other healthcare professionals in altering their emotional response to reactant behaviour avoiding a decreased sense of self-efficacy. Concluding remarks The current paper addressed an intrinsic human characteristic, psychological reactance, as a factor that may influence the outcome of physician-oriented intervention strategies, including those typically delivered by pharmacists. Although psychological reactance has not been tested from a healthcare provider’s perspective, there is enough research to suggest the basic cognitive process represented is universal and also valid in the context of clinical care recommendations in the healthcare setting. Indeed, reactance theory fits well as it offers some explanation of why at times valid recommendations fail to have the desired impact on physician behaviour. It is possible that as human beings, even healthcare professionals are subjected to the same human emotions and weaknesses as humans in general. However, a role for reactance in clinical care recommendations needs to be investigated empirically. If this role is established, factors likely to increase the potential for reactance may need to be taken into account when implementing intervention strategies that attempt to influence physician behaviour. It also is acknowledged that physician non-compliance to valid recommendations is more likely to be a complex, multi-faceted phenomenon. Physicians may not adhere to evidence based recommendations for a number of reasons unique to the individual patient, and the circumstance. It is most likely that reactance, although a powerful determinant of behaviour in general, is only one of the many factors that influence decision-making in relation to clinical care/pharmacotherapeutic recommendations.