Association of Clinician Denial of Patient Requests With Patient Satisfaction

Abstract

Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. OBJECTIVE To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. MAIN OUTCOMES AND MEASURES We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach α = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)-referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test-compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. RESULTS The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, −19.75 [95% CI, −30.75 to −8.74], −10.72 [95% CI, −19.66 to −1.78], −20.36 [95% CI, −29.54 to −11.18], and −9.19 [95% CI, −17.50 to −0.87]), respectively. CONCLUSIONS AND RELEVANCE Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.

Patient Characteristics Associated with Making Requests during Primary Care Visits

“…Patient requests are the norm rather than the exception in primary care visits, and how physicians respond to requests has a powerful impact on whether patients are satisfied with primary care visits. 5 As patients may often request lower-value services, 8 primary care physicians need skills in handling requests such that patient concerns can be successfully addressed without acceding to requests for low-value or inappropriate services. While our study did not assess whether patients requested lower-or higher-value care, our findings highlight several patient subgroups that are particularly likely to make requests and for whom primary care physicians are more likely to need skills in request handling.…”

How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis

“…A recent study showed the denial of a patient request for pain medication was associated with lower patient satisfaction scores. 46 This has discouraged some of the best and most caring physicians who try to provide quality care. Although the Joint Commission, IOM, and CMS had good intentions of involving patients in their care, some of the ramifications were that patients received more opioids and other controlled substances when requested.…”

When Physicians Say No: Predictors of Request Denial and Subsequent Patient Satisfaction

“…8,[13][14][15] Previous work also has shown that denials of patient requests are associated with lower patient satisfaction. 1,2 Our findings suggest that physician continuity may mitigate the adverse impact of request denials on patient satisfaction. Within continuity relationships, patients may feel confident that they may ask their usual physician to fulfill the denied request in the future if their symptoms or concerns persist, and may be more likely to accept a denial from a physician they know without reducing satisfaction in the visit.…”

“…Patients make requests of their physician at many primary care office visits, including requests for medications, laboratory tests, imaging tests, or specialty referrals. 1,2 Prior studies have shown that physician denial of requests is associated with lower patient satisfaction. [1][2][3][4][5] However, we know little about patient characteristics that may be associated with denial of their requests, or which factors predict lower patient satisfaction in the context of a denied request.…”