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Reasons for Administration and Patient Responses to Proposed Discontinuation

Larry Lawhorne, MD; David Ringdahl, MD

JAMA. 1989;261(13):1920-1923.

Abstract
We reviewed the records of 1222 patients who attended a newly acquired rural satellite clinic and found that 120 (10%) had been receiving regular cynocobalamin injections, but that only 4 (3%) met accepted criteria for its administration. Open-ended interviews with 48 of these patients revealed that they had been receiving cyanocobalamin injections for a mean of 9.9 years for 3.3 symptoms each and with a mean effectiveness rating of 2.9 (scale, 0 to 4). After receiving education regarding the appropriate indications for cyanocobalamin injections, 25 (52%) of the patients were willing to stop receiving them at least temporarily. However, 18 patients (38%) who were younger and who reported greater symptom relief would actively seek a physician who would continue to administer cyanocobalamin. Our findings suggest that some patients who have been receiving cyanocobalamin injections but who do not have a documented deficiency will stop receiving the injections when presented with reasonable alternatives.

(JAMA. 1989;261:1920-1923)

Author Affiliations
From the Fayette (Mo) Medical Clinic (Dr Lawhorne) and the Department of Family and Community Medicine, University of Missouri, Columbia (Drs Lawhorne and Ringdahl). Dr Ringdahl is now with the Department of Family Practice, Physicians Plus Medical Group, DeForest, Wis.

Footnotes
Reprint requests to the Fayette Medical Clinic, Elm and Church Streets, Fayette, MO 65248 (Dr Lawhorne).

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