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Study claims denying patient requests lowers physician ratings

Physicians often lack training on how to deal with patient requests, which can impact patient satisfaction survey results.

Jeff Lagasse, Associate Editor

Patients who ask for specialist referrals, laboratory tests or certain medications and don't get them tend to be less satisfied with their doctors than those whose requests are fulfilled, new research from UC Davis Health shows.

Based on the results, the authors recommend communications training for physicians that fosters positive experiences for patients without agreeing to all requests for particular diagnostics or treatments.

[Also: Clinician satisfaction tied to healthy workplace, report says]

It's common for patients to approach their doctor with specific requests, and many of those requests are reasonable. Some, however, are for services of dubious value that could either be health-neutral or have a detrimental effect. The research shows that physicians often lack training on how to deal with those situations -- which is problematic in a healthcare landscape that emphasizes patient satisfaction survey results to determine physician compensation.

The study included over 1,100 patients in the family and community medicine clinic at UC Davis Health. Over the course of nearly a year, they answered survey questions about office visits with their doctors, including their requests for medical services, assessments of the doctor's communications and understanding, and overall ratings of the doctor.

[Also: How a 5-minute hospital intervention can improve inpatient satisfaction]

Patients made nearly 1,700 specific requests of their doctors. When those requests were fulfilled -- which was about 85 percent of the time -- satisfaction with clinicians was generally high. But when patient requests for referrals, pain medications, other medications and tests were denied, clinician satisfaction ratings significantly lowered, by 10 to 20 percentage points.

The differences were noteworthy since the analyses accounted for a broad range of patient characteristics, such as gender and race/ethnicity, which prior research has shown can influence satisfaction ratings.

The authors now hope to study whether training physicians to effectively manage patient requests could improve this situation. Based on previous research, mostly related to antibiotic use, Jerant believes a strategy known as watchful waiting, a middle ground between a flat denial and immediate "yes," could be useful to physicians.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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