Clinician denial of certain patient requests linked with decreased satisfaction

1. In an observational study of a single family practice clinic, clinician-patient interactions in which a request was denied was linked to lower patient satisfaction even after adjustment for known patient confounders.

2. Requests for referrals, pain medications, other medications, and laboratory tests were associated with greatest deleterious effects on patient satisfaction. Patient requests for radiologic tests, other tests, and antibiotics, were not shown to have an impact on patient satisfaction.

Evidence Rating Level: 3 (Average)    

Study Rundown: There is a growing emphasis on the subjective patient satisfaction during clinician interactions in the systems for physician remuneration in the United States. A drive towards patient-centered care has added to the importance in improving communication and involving patients with their care. However, how specific interactions may influence satisfaction scores remain a concern. The current study sought to evaluate the effect of physician denial of a patient request on satisfaction scores while adjusting for known confounders including patient demographics, BMI, patient self-reported health status, and attitudes towards medical care. The study found that requests for referrals, pain medications, other medications, and laboratory tests were associated with the greatest decrease in patient satisfaction.

The current study confirms that physician refusal of patient requests can negatively impact patient satisfaction, while providing evidence that specific requests have a more profound effect than others. Targeting training towards improving communication during these negative interactions may help lessen patient dissatisfaction and prevent clinician acquiescence to demands for low-value care. The study has a major strength in that it adjusted for confounders that are known to impact patient satisfaction. The main limitations of the study include its small size at a single center, reliance on patient reported data rather than direct observations, and lack of information on the nature of requests in terms of low-value care of utility.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Promoting Patient-Centered Counseling to Reduce Use of Low-Value Diagnostic Tests

In-Depth [survey]: The study is a observational study that included English-speaking patients over the age of 18 who were seen at a single family medicine clinic in California from July 2015 to May 2016. Data was collected by survey immediately following office visits. Satisfaction was evaluated using 6 questions from Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) Adult Visit Survey. Participants also answered questions related to known satisfaction confounders and on whether they had made and received any requests for referral to another clinician; pain medication; antibiotic; other new medication; laboratory testing; radiology testing; or other testing.

The study found that of 1691 patient requests across 1319 visits, 85.2% were fulfilled. Clinician denial of request was linked to decreased satisfaction for referrals (−19.75 [95%CI, −30.75 to −8.74]), pain medications (−10.72 [95%CI, −19.66 to −1.78]), other medications (−20.36 [95%CI, −29.54 to −11.18]), and laboratory testing (−9.19 [95%CI, −17.50 to −0.87]).

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