When Physicians Say No: Predictors of Request Denial and Subsequent Patient Satisfaction

Elizabeth M. Magnan, Peter Franks, Anthony Jerant, Richard L. Kravitz, Joshua J. Fenton

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Physician denial of patient requests is associated with lower patient satisfaction. Our objective was to explore factors that influence physician request denial and patient satisfaction after request denial. METHODS: Cross-sectional observational study of 1141 adult patients seen during 1319 outpatient visits with 56 primary care physicians. We measured patients' postvisit self-report of requests and request fulfillment, visit satisfaction, sociodemographics, health status, symptom burden, life satisfaction, medical skepticism, and whether patients saw their usual physician and a faculty or resident physician. We used mixed-effects regression analyses to identify predictors of request denial and visit satisfaction among patients who had a request denied. RESULTS: Patients made at least 1 request at 867 visits (65.7%) with at least 1 denied request reported at 182 visits (21.0%). Patients who saw their usual physician were less likely to report a request denial (adjusted Odds Ratio [aOR], 0.61; 95% CI, 0.42 to 0.88), and patients with the highest symptom burden (aOR, 2.21; 95% CI, 1.38 to 3.55) or greater medical skepticism (aOR, 1.35; 95% CI, 1.03 to 1.78) were more likely to report request denials. After request denials, patients seeing their usual physicians reported significantly greater visit satisfaction compared with not seeing their usual physician (adjusted percentile rank in visit satisfaction: 12.4%; 95% CI, 3.5% to 21.2%). CONCLUSIONS: Approximately one fifth of visits in primary care have a denied request. Having an office visit with one's usual physician is associated with reduced likelihood of request denial and may mitigate the adverse impacts of request denial on patient visit satisfaction.

Original languageEnglish (US)
Pages (from-to)51-58
Number of pages8
JournalJournal of the American Board of Family Medicine : JABFM
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Patient Satisfaction
Physicians
Odds Ratio
Denial (Psychology)
Office Visits
Primary Care Physicians
Self Report
Health Status
Observational Studies
Primary Health Care
Outpatients
Cross-Sectional Studies
Regression Analysis

Keywords

  • Cross-Sectional Studies
  • Outpatients
  • Patient Satisfaction
  • Personal Satisfaction
  • Physician-Patient Relations
  • Primary Care Physicians
  • Regression Analysis
  • Self Report

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

When Physicians Say No : Predictors of Request Denial and Subsequent Patient Satisfaction. / Magnan, Elizabeth M.; Franks, Peter; Jerant, Anthony; Kravitz, Richard L.; Fenton, Joshua J.

In: Journal of the American Board of Family Medicine : JABFM, Vol. 33, No. 1, 01.01.2020, p. 51-58.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Physician denial of patient requests is associated with lower patient satisfaction. Our objective was to explore factors that influence physician request denial and patient satisfaction after request denial. METHODS: Cross-sectional observational study of 1141 adult patients seen during 1319 outpatient visits with 56 primary care physicians. We measured patients' postvisit self-report of requests and request fulfillment, visit satisfaction, sociodemographics, health status, symptom burden, life satisfaction, medical skepticism, and whether patients saw their usual physician and a faculty or resident physician. We used mixed-effects regression analyses to identify predictors of request denial and visit satisfaction among patients who had a request denied. RESULTS: Patients made at least 1 request at 867 visits (65.7{\%}) with at least 1 denied request reported at 182 visits (21.0{\%}). Patients who saw their usual physician were less likely to report a request denial (adjusted Odds Ratio [aOR], 0.61; 95{\%} CI, 0.42 to 0.88), and patients with the highest symptom burden (aOR, 2.21; 95{\%} CI, 1.38 to 3.55) or greater medical skepticism (aOR, 1.35; 95{\%} CI, 1.03 to 1.78) were more likely to report request denials. After request denials, patients seeing their usual physicians reported significantly greater visit satisfaction compared with not seeing their usual physician (adjusted percentile rank in visit satisfaction: 12.4{\%}; 95{\%} CI, 3.5{\%} to 21.2{\%}). CONCLUSIONS: Approximately one fifth of visits in primary care have a denied request. Having an office visit with one's usual physician is associated with reduced likelihood of request denial and may mitigate the adverse impacts of request denial on patient visit satisfaction.",
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