Denying patient requests, specifically for referral, pain medications, or new medications, is associated with worse patient satisfaction and lower physician ratings, according to findings from a cross-sectional observational study published in JAMA Internal Medicine.

Researchers assessed patient satisfaction of 1141 adult patients who submitted specific treatment-related requests to family physicians. To measure patient satisfaction, the investigators used the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey.

Approximately 68.0% of the 1319 outpatient visits assessed in this study featured ≥1 patient request. Of these requests, a total of 1441 (85.2%) were fulfilled by the physician. The greatest proportion of requests were for laboratory tests (34.0%), followed by referrals (21.1%), requests for pain medication (20.5%), new medications (20.5%), radiology tests (11.6%), and antibiotics (8.1%). Compared with request fulfillment, denials were associated with worse patient satisfaction for referrals (adjusted mean percentile difference, −19.75; 95% CI, −30.75 to −8.74), pain medication (−10.72; 95% CI, −19.66 to −1.78), or new medications (−20.36; 95% CI, −29.54 to −11.18).

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Nonverbal or unwritten factors, patient characteristics, and other elements not quantified in this study could have influenced satisfaction scores in this cohort. Additionally, the small sample sizes for some of the request categories may limit the ability to generalize the findings across the population.

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“In the current era of clinician compensation tied partially to patient satisfaction ratings,” the investigators stated, “we believe our findings provide guidance to clinicians and healthcare administrators charged with delivering high technical quality, cost-effective care while also optimizing patients’ subjective experiences of care.”


Jerant A, Fenton JJ, Kravitz RL, et al. Association of clinician denial of patient requests with patient satisfaction [published online November 27, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.6611