Most doctors found guilty of inappropriate prescribing either lack the assertiveness to say no to patients or are working in isolation from their colleagues, an Australian-first analysis suggests.

Researchers reviewed 117 misconduct cases involving either inappropriate supply or misappropriation of medicines by doctors, pharmacists or nurses.

Of the 52 doctors covered in the study, 16 were categorised as lacking the assertiveness to manage complex patients and 15 were seen as lacking support or isolated.

The typical case was a doctor prescribing large doses at frequent intervals to patients who were doctor-shopping — either because of substance use disorders or because they were in the “image enhancement community”, such as body-builders, according to lead author Shann Hulme from the National Drug and Alcohol Research Centre in Sydney.