Researchers examined data on 1,141 patients with a total of 1,319
doctor visits. Overall, about two-thirds of these visits included at
least one patient request for the doctor to provide a particular
specialist referral, lab test, pain drug or other prescription
Doctors fulfilled these requests 85% of the time, the study found.
When doctors didn’t acquiesce, however, patient satisfaction scores
in surveys after the visits were dramatically lower than when
requests were fulfilled.
“This was a stronger effect than we expected, particularly given we
had adjusted for all kinds of other things that could influence
satisfaction,” said lead study author Dr. Anthony Jerant of the
University of California Davis School of Medicine.
Part of the problem may be how often doctors are saying “yes” to
patient requests, Jerant said by email.
“This is strongly the norm in the patient’s mind - they ask for
something, and a very strong majority of the time they get it,”
Jerant said. “A request denial, therefore, is quite out of the
ordinary and probably likely to invoke a negative reaction.”
Patients in the study were 46 years old, on average, and saw one of
56 family physicians for outpatient visits at an academic medical
center in Northern California.
The most common requests were for lab tests, followed by specialist
referrals, pain medication or other prescription drugs, radiology
tests, other lab work and antibiotics.
Satisfaction scores ranged from -30 (lowest) to +30 (highest), with
zero representing an average, or neutral, level of satisfaction.
Satisfaction was lowest for denials of requests involving referrals
to another clinician (-20), non-pain prescription drugs (-20), pain
medications (-11) and lab tests (-9).
There wasn’t a meaningful difference in patient satisfaction based
on whether or not doctors fulfilled requests for antibiotics,
radiology or other tests.
The results suggest that doctors may need to do a better job in some
cases of explaining their rationale for refusing a patient’s
request, the authors conclude.
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Beyond its relatively small size, another limitation of the study is
that the results only involved a single health system and might not
reflect patient satisfaction elsewhere, researchers note online
November 27 in JAMA Internal Medicine.
Even so, the results underscore the fact that doctors often agree
with patients about what referrals, prescriptions or tests might be
best, said Dr. Joseph Ross, author of an accompanying editorial and
a public health researcher Yale University in New Haven,
When doctors disagree with patients’ requests, the study results
suggest that it matters how doctors explain their decision, Ross
said by email.
The reasons for patients’ requests matter, too. Sometimes patients
have seen a treatment advertised on television, or heard about it
from a friend or family member. Other times, patients aren’t happy
with their care and think a specialist may be needed.
“I think physicians are often wary of denying care that has been
requested by patients, both because it will impact satisfaction and
because it takes longer to explain to a patient why a service is not
needed than to simply agree and process the order,” Ross added. “To
me, the key is that physicians and patients communicate clearly so
that the care decisions are being shared and are in the best
interest of patients.”
SOURCES: http://bit.ly/2ADgd9e and http://bit.ly/2BrkmtU
JAMA Intern Med 2017.
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