How is patient satisfaction related to denial of different types of patient requests?

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. (LOE = 2b)

Jerant A, Fenton JJ, Kravitz RL, et al. Association of clinician denial of patient requests with patient satisfaction. JAMA Intern Med 2018;178(1):85-91.  [PMID:29181542]

Cross-sectional

Self-funded or unfunded

Outpatient (primary care)

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.