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Denying some patient requests worsens patient satisfaction with their care
Clinical Question
How is patient satisfaction related to denial of different types of patient requests?
Bottom line
In this study of a family medicine practice with relatively young, healthy, educated, patients (the majority women), patient satisfaction scores were lower when patients were denied requested referrals to other physicians, pain medication, a new medication, or a specific laboratory test. Unfulfilled requests for antibiotic prescriptions, however, did not affect overall satisfaction scores. 2b
Reference
Study design: Cross-sectional
Funding: Self-funded or unfunded
Setting: Outpatient (primary care)
Synopsis
This study surveyed 1341 adult, English-reading patients after a visit to 1 of 56 family physicians or residents in a single office. The patients' average age was 45.6 years, 68.4% were women, more than 80% had at least some college education, 78% rated their health good to excellent, and 47.4% were non-Hispanic white. Almost half (43.4%) of the visits were with a physician the patient had seen before. Immediately following the visit, patient satisfaction was measured using 6 items from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey that focused on communication and overall physician rating. Patients were also asked if they had requested any 1 of 7 services and whether the request was met. Overall, 68% of visits included at least 1 request; patients reported 85.2% of their requests were fulfilled by their physician. Unmet requests for referral to another physician, pain medication, a new medication, or a laboratory test were associated with lower satisfaction as compared with visits in which those requests were fulfilled, ranging from a difference of 9 percentage points in satisfaction for a denied laboratory test to a difference of 20.36 percentage points for a denial of another new medicine. A denied request for antibiotic prescription, radiology testing, or other tests was not associated with lower satisfaction.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Speaks more to cultural expectations than quality of care. Displays some of the societal pressures placed on primary care providers -would be interesting to be able to compare patient clinical outcomes between those who were and were not denied referrals or tests.
I’m not sure who would be surprised with this study, people don’t get what they want Are not as happy. What a surprise!
I find that careful explanation of why a request may not be fulfilled, together with reference sources almost always solves the dissatisfaction issue. It takes a little time but that is our job. After all , "doctor" is derived from the Latin verb 'doceo', " I teach".
Satisfaction
Why do we worry so much about satisfaction? We do have a role as gatekeeper and if we gave everyone what they think would make them satisfied, we would be way over testing, over treating and we would have an opioid crisis and a bankrupt system. Oh, wait a second...
This is totally not surprising. We live in a society of entitlement and patient knows best. Unfortunately if you strictly apply the principles of Choosing Wisely, Canada, we are going to have many high scores of dissatisfaction for many items. Those who simply cave and give the patient what he or she wants are rated better by the patient (but not by our peers or regulators).
Patient will continue to ask for more investigation, all covered by tax payers’ money in Canada!a
So is this study suggesting we should be in the business of patient satisfaction rather than best health care practices and judicious use of public resources? What a waste of time and effort this study was.
Surprising and very helpful re x-rays and antibiotic refusal being ok. Fits into choosing wisely
this is why I prefer to take on patients with something actually wrong with them. The worried well are not my favourite patients
Patient with spinal disorder and chronic pain has a lot request for example a different pain medication sleeping and these day marijuana they all frustrated they they seen multiple physician with different speciality,They need to know that you understand their frustration you have spend time with them I semiretired no call no surgery no prosuedugers so I have time time to talk to them explain and admit that there is no medical treatment for their condition explain what MRI may show explain healthy living avoid inactivity do short but frequent stretching during day do a complete exam pay attention to pain area and give follow up in a year they proudly report they still have but they are able to control that.
This confirms what I think we all know. I think this is useful evidence to remind us that patient centered care has limits, that patient satisfaction is not the same as good care (making the assumption here that these denials of care were appropriate).
Which patients?
This doesn't tell us anything about whether an established relationship with a patient makes a difference. "Almost half (43.4%) of the visits were with a physician the patient had seen before," which means 56.6% of the patients were seeing a doctor for the first time. And had the 43.4% seen the doctor only once before? Does a long-term relationship change this dynamic?
Dissatisfied patients doesn't mean I will give inappropriate care.
Physician-patient interaction is complex. There Is no quantifier of trust in the physician-patient relationship. Almost half of the encounters were with a doctor seen for the first time. This makes the study almost uninterpretable.
It would have been revealing to survey the physicians about the time consumption of denying these requests. Saying ‘no’ challenges the relationship. As this educated patient cohort come in with more internet-informed requests for meds & tests, I think these challenges become more & more frequent. Is there a comparable rating scale for physician satisfaction from these saying ‘no’ encounters I wonder.
It would be interesting to know which country this study was conducted in.
Vu que ces patientes sont moins satisfaites de leurs visites à la suite plus particulièrement du refus d’un nouveau médicament, je pense qu’on peut diminuer cette insatisfaction en justifiant notre décision un peu plus sans être argumentatif.
Good poem
This does not mean that we acquiesce to patient demands. What it does mean is that we explain to the patient why we think they do not need the request they are making. This very much aligns with the Choosing Wisely that we are trying to implement. It means we talk more to the patient, something many doctors are reluctant to do....it is often easier/quicker to give a prescription or a lab req than to explain your reasoning to the patient.
What do you expect with consumer oriented focus and doctor Google. Contrast this with focus on limiting health care spending and evidence based investigations and you have a conflict of expectations with doctors in the middle. It takes more time to convince that tests are not warranted with less satisfaction - no win situation.
I wonder if any of the 7 requested services were for Tax Disability Credit form.
Explaining why a requested medical test or treatment may not be appropriate is an expected part of a doctor's work. Arguing about massaging the truth on a gov't form for financial gain should not be.
sorry but this was dumb. of course people are less satisfied if they don't get what they want. but if we do a better job of communicating the reason WHY we aren't giving them every request they will be less dissatisfied. We should not care about pt satisfaction if it means doing what is not medically appropriate
By this I mean that I really try to explain my rationale for denying referrals, medications, or tests that a patient might have requested. Almost always, if the patient feels that they understand the reason for not complying with a specific request, the patient leaves feeling satisfied. I suspect that the widespread public information about avoiding antibiotic overuse is the reason why patients don't seem to mind being denied an Rx for antibiotics.
So saying no results in dissatisfaction! I see the same in my 3 and 7 year old children.
Apparently the idea that an antibiotic or xray (other imaging too?) isn't needed is reassuring, while not getting a lab test or specialist opinion isn't?!
I wonder if the pain medications which weren't prescribed were opioids?
A mixed bag of information.