People who ask their doctors for specialist referrals and certain tests or medications, but then don’t receive them, tend to report less satisfaction with their doctors than people who have their requests fulfilled, research shows.
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The authors of the study are now recommending that doctors receive communications training that fosters positive experiences, without them agreeing to every specific request regarding diagnosis or treatment.
As reported in JAMA Internal Medicine, lead author Anthony Jerant and team conducted a study involving more than 1,100 patients in the family and community medicine clinic at UC Davis Health. Over almost one year, the participants answered survey questions about visits to their doctors. They described the medical services they had requested, how the communications were with their doctors and how they found their experiences overall.
Jerant and colleagues found that almost 1,700 specific requests were made and that when these were fulfilled (around 85% of the time), patients generally reported satisfaction with their clinicians. When patient requests for certain referrals and medications were denied, however, the rate of satisfaction lowered significantly, by up to 20%.
It is common for patients to come to the doctor's office with specific requests in mind... Many of those requests are highly reasonable, but some are for services of questionable or low value that are unlikely to improve health or could even be harmful.”
Anthony Jerant, UC Davis Health
Jerant explains that physicians are often not trained in how to deal with such situations, which is vital, given the importance that is placed on patient-satisfaction survey results in terms of improving healthcare and sometimes physician compensation.
The authors are now planning to study whether training physicians in how to manage patient requests effectively could help to improve the situation. Previous research, mainly based on antibiotic use, has led Jerant to believe that the “watchful waiting” strategy may be the answer. Watchful waiting is a middle ground between outright refusal of a request and the immediate granting of it.
"It is challenging for primary care clinicians to balance patients' needs, good stewardship of health care resources and time efficiency during office visits," says Jerant. "Training clinicians to effectively handle patient requests could help them achieve that balance in their practices."
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