Patient Satisfaction and Denials of Service Requests

If we want to know why health care costs so much, we really just have to look in the mirror.  Poor health behaviors is a big part, as are poor health management behaviors.  Research in the Journal of the American Medical Association Internal Medicine finds that if a physician denies patients’ requests for services, he or she is more likely to see lower patient satisfaction.   (JAMA Int. Med. Art.)   1141 adults were involved in the study which evaluated their patient satisfaction reports following requests for services, which might include a referral, pain medication, an antibiotic, another new medication, a lab test, an imaging study or some other test.  Prior studies suggest as many as 75% of primary care visits include a service request by a patient.  Patient satisfaction was elicited from a standard scale completed right after the visit, and it would be interesting to see if the timing itself affected the scores.  On reflection a patient might rate satisfaction higher or lower.  Sociodemographic and health status factors were used to adjust the study analyses.  68% of the participants were female.  A very large percent of the requests were granted, 85.2%.  Wonder if that is too high, particularly since some services, like lab tests and pain medication, which are very subject to abuse, were among the most requested.  Only for imaging did request fulfillment dip below 80%, in that case to 66%.

Denials of requests for pain medication, referrals, other medications and lab tests were associated with statistically significant lower satisfaction ratings, and denials for imaging and for other testing led to lower scores, but the results were not statistically significant.  The drop in scores was quite large.  This could lead to provider shopping, or to the same provider not denying services as much in the future.  The authors suggest that more emphasis can be put on physician communication to patients regarding denied requests, but doctors are generally under tremendous time pressures, so I don’t think this is very realistic.  We need to rethink how patient satisfaction is measured and how scores are used.  Right now providers get penalized for low scores, so we putting them in a conundrum in which they may do the right thing in terms of appropriate care use and spending, but get lower patient satisfaction scores.  Patient experience of and satisfaction with care is important, but is also complex and does not necessarily have a relationship to other, equally or more important, outcomes, including direct health quality ones.  We can’t expect doctors to be cost-conscious if they are worrying about the impact of a low patient satisfaction rating.