Advocates for Evidence-Based Health Policy Speakers
The Customer Is(n’t) Always Right
Patient satisfaction is currently gaining more attention in the healthcare system as physician’s compensation is becoming increasingly linked to patients’ subjective approval of their overall office visit. Several studies have found that a patient’s approval of their appointment is a reflection in part of the physician’s interpersonal skills. In light of this knowledge, are there practical approaches to improving patient satisfaction ratings that physicians can implement in an office visit without sacrificing productivity and overall health outcomes?
In a recent study, the authors explored the effect of denying certain patient requests on satisfaction ratings, including withholding of referrals to another clinician, pain medication, antibiotics, other new medications, and laboratory and radiology testing. After controlling for several characteristics shown previously to influence satisfaction ratings, it was found that denial of some requests had a significant correlation with lower patient satisfaction ratings while other denials were unrelated.
Denials of requests for pain medication, referrals, new medications (other than antibiotics or pain medications), and laboratory tests were all associated with worsened average patient satisfaction ratings, 10 to 20 points lower than visits where these requests were fulfilled. On the contrary, denials of antibiotics, radiology tests, and other tests were not associated with lower satisfaction.
When considering these results, it is worrisome that satisfaction ratings are linked to pain medication requests while our nation is facing an opioid epidemic. Having physicians’ salaries tied in part to how satisfied their patients are leads to the temptation to over-treat or use un-indicated measures, including overprescribing pain medications, to improve ratings. This concern should be considered by policy makers who are now facing a nationwide public health crisis. We need counter measures to combat the risk of placing satisfaction over high quality care especially if physician salaries are going to be linked to satisfaction ratings.
We should attempt to better understand ways to mitigate the effect of denying certain patient requests on the outcome of patient satisfaction. Additionally, physicians may require supplementary training to discover best practices to deny unnecessary patient requests for pain medications and referrals without hindering patients’ overall experience of care.
This Policy Prescriptions® review is written by Mary Tillman as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where she is a medical student.
Abstract
IMPORTANCE: 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 ??=?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.
PMID: 29181542
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