Denying Certain Requests May Reduce Patient Satisfaction

Patient satisfaction is acknowledged as an important part of patient-centered care; however, some controversy exists regarding how honoring patients’ requests fits into this paradigm. A study published yesterday in JAMA Internal Medicine found that denial of several types of patient requests is associated with lower patient-satisfaction ratings of the physician. Specifically, denials of requests for referral, pain medication, other new medications, and laboratory tests were associated with significantly worse patient satisfaction.

“In an era of satisfaction score–driven compensation of clinicians, the findings suggest the need to explore the utility of training clinicians to better handle patient requests, potentially optimizing the patient experience while also enhancing clinician career satisfaction,” Anthony Jerant, M.D., and colleagues at the University of California Davis School of Medicine, Sacramento wrote.

For the study, Jerant and colleagues asked 1,141 patients to rate their satisfaction immediately after 1,391 office visits with 56 family physicians. Patient satisfaction was measured using a scale composed of six items from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey, which included questions about whether the patients felt the physician communicated in a way they could understand, spent enough time with them, and whether they would be likely to recommend the physician to their family and friends.

Study participants were also asked whether during the appointment they had made requests for the following services and, if so, whether they perceived that the physician had fulfilled or denied these requests: referral to another clinician; new medications; or follow-up tests, including laboratory and radiology tests.

Among 1,319 visits, 897 (68.0%) included at least one request; 1,441 (85.2%) were fulfilled. Compared with fulfillment of a request in the respective category, denials of requests for pain medication, referral, other new medication, and laboratory tests were associated with a significantly worse patient satisfaction rating of the physician. In contrast, denials of requests for antibiotics and referrals for imaging tests were not associated with worse patient satisfaction.

“[I]t is no coincidence that antibiotic prescription and imaging test referral were not associated with lower satisfaction,” JAMA Internal Medicine Associate Editor Joseph S. Ross, M.D., M.H.S., wrote in a comment reflecting on the findings. He noted that “substantial attention has been devoted to preparing physicians to avoid frequently requested, low-value care such as these. We can train physicians to say no to other types of clinically inappropriate requests, while still reassuring patients and paying attention to their needs.”

For related information, see the Psychiatric Services article “Association Between Quality Measures and Perceptions of Care Among Patients With Substance Use Disorders.”

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