Patients in the US are taking more control of their health, and don’t like it when their doctors get in their way.
In new analysis of over 1,300 doctors’ visits in northern California, researchers from the University of California Davis found that when doctors deny specific requests made by patients—for drugs, image screening, or referrals to specialty doctors, for example—patients tended to rate their doctors less favorably.
These findings are significant as doctors in the US are increasingly incentivized to please patients and have them return. Hospital systems are switching over to models where doctors are paid based on patient satisfaction, as both government-sponsored healthcare and private insurance are including quality measures in their contracts to work with them. This kind of payment model was incentivized first by government-run healthcare programs like Medicare and the Affordable Care Act, Modern Healthcare reports, presumably as a way to ensure that all patients are receiving the care they need.
But patients, of course, don’t always make the best doctors. Although they should always advocate for their own health, that doesn’t always mean that they should get what they think they need—no matter what the internet says.
For the study, which was published on Nov. 27 in JAMA Internal Medicine, researchers asked 1,141 patients to fill out surveys after 1,319 doctors visits. These surveys asked about what happened in the visit, and for patients to rank how they felt afterward. Patients were given a $10 gift card for their time.
In 68% of these visits, patients asked their doctors for something specific, like a painkiller, another prescription, additional medical testing, or a referral to see another doctor. Patients got what they came for in 85% of those visits. But when they didn’t, study authors noticed they tended to rate their doctors a lot less favorably. Patients were most dissatisfied with their doctors when they were denied referrals to other doctors, other medications, painkillers, and other types of medical testing.
The authors think that patients have gotten used to getting what they want. “This is strongly the norm in the patient’s mind,” Anthony Jerant, a family physician in California and lead author of the paper, told Reuters. “A request denial, therefore, is quite out of the ordinary and probably likely to invoke a negative reaction.”
Reinforcing this is the fact that the US is one of only two the countries that allow direct-to-consumer advertising for medical services (the other is New Zealand). When patients are aware that there are drugs available to them, they’re more likely to go in and ask for something specifically, rather than just describing their symptoms.
This puts American doctors in a tough spot. They don’t want to give patients medicine or treatments they don’t need—especially if it’s expensive or comes with potential side effects. But they also want to make money. If their pay is tied to patient satisfaction, it’s in their best interest to give patients what they ask for.
Better communication is key, the authors argue. If physicians can explain why they don’t want to recommend a particular medication or scan, patients will feel reassured that at least their doctors took the time to understand their complaints. This seems to have worked with regard to antibiotics. Patients who were denied these pills rated their doctors slightly above neutral, which suggests to the authors that maybe, doctors have gotten a lot better at explaining why these pills aren’t suitable for every ailment.