Patients react poorly when documents say & # 39; No & # 39;


TUESDAY, Nov. 28, 2017 (HealthDay News) – Patients used to see doctors as kind but firm professionals, experts who knew what they were talking about and should be paid attention to, even if they did not. "Necessarily welcome."

But these days, people have become demanding health care consumers, and do not respond well when a doctor disagrees with them, a new study shows.

The researchers found that two One-third of patients arrive at their doctor's office with a specific medical request that is already in mind: look for a medication, a test or a referral.When your doctor rejects that request, they are more likely to be offended and criticized a patient satisfaction survey.

Satisfaction scores plummet when doctors deny the requests of almost any patient, but especially when patients have requested a prescription for medication or a referral, the study found.

problem for doctors is that their salary has become increasingly tied to their patient satisfaction scores, said the principal investigator of the study, Dr. Anthony Jerant. He is a professor of family and community medicine at the University of California, Davis School of Medicine.

"Many doctors are tempted to accept and administer the painkiller or test them, although they know that it is really not likely to be useful," Jerant said. "We really have to think again about reimbursing doctors in part on their satisfaction scores."

For this study, Jerant and colleagues reviewed 1,319 visits to 56 family physicians at the UC Davis Family Medicine Clinic. Visits were made by 1,141 adult patients. Patients were asked to complete a questionnaire after their visit.

Patients came to their doctor's office with a specific request 68 percent of the time, the researchers found. They frequently requested a laboratory test (34 percent), a referral (21 percent), painkillers (20 percent), or another new medication (20 percent).

About 85 percent of the time, doctors met their patients' requests, the results showed.

"In general, doctors will listen to patients and, if they think the request is reasonable, they will say yes," Jerant said. "But some of those requests maybe should not have been fulfilled."

Nowadays, people in doctors' waiting rooms are much more likely to have learned about a new medication from a television ad or have searched "Dr. Google" for their symptoms, said Dr. Cynthia Smith , vice president of clinical programs at the American College of Physicians.

"It is likely that people have already tried to solve their problem by searching the internet," said Smith.

For example, a person with a headache may have a cousin with brain cancer and learned from a quick search on the Internet that a scan of images could detect a brain tumor, he explained.

According to Dr. Joseph Ross, badociate professor at the Yale School of Medicine, "Patients may have several reasons for requesting a service or recommendation, they may have seen a television service announcement or a friend or The family that received it in the past has had a good result, they are already dissatisfied. "

When doctors reject patients' requests, patients react badly, the researchers found.

Satisfaction scores plummeted an average of 20 points. when the doctors denied a reference request or a new medication, and 10 points when they said no to a prescription for badgesics, according to the report.

Physicians also got worse evaluations when they rejected requests for lab and imaging tests. [19659002] Only one type of unfulfilled request did not leave the patients furious, the study authors noted.

A rejected request for antibiotics actually led to a slight increase in patient satisfaction scores.

"We think it's because the message finally came out on antibiotics," Jerant said, referring to the increase in germs resistant to antibiotics.

"Not only were there fewer requests for antibiotics, [but] was not badociated with a blow to satisfaction, that's really hopeful because it suggests, as the reaction against opiates gains momentum, we can eventually see the same thing for requests for pain medication, "he said. "Patients would be a little more likely to say that the document is correct."

Jerant and Smith agreed that physicians need training to better communicate with patients about these requests.

"They're just patients legitimately seeking help and comfort, and we do not want to silence that," Jerant said. "We do not want to put patients in a position to guess if they should go in and ask for something, it's really how the doctor responds."

Smith suggested that doctors should probe a little deeper and discover the medical concern behind a patient's request for a certain medication or test.

"We discovered that it really does not take much extra time, and when it's done well, it can really deepen the relationship because you know something about your patient that you did not know before," he said. "You have to individualize care for the patient in front of you."

Alternatively, Jerant said, it has been shown that a "watchful waiting" approach helps.

In this approach, the physician acknowledges the patient's concern, but indicates that, in the physician's honest opinion, the requested test or medication is not likely to help. The doctor would add something like, "How about we monitor the situation for X amount of time and, if you do not feel better or feel worse, we will regroup," he explained.

"It does not collapse immediately, but it does not say" no, I do not want to do that, "Jerant said." It gives the patient a middle ground. "

This approach has been promising enough for Jerant. try it in a clinical trial.

"We think there are reasons to suspect if you use that approach instead of just saying no, patients may be inclined to react less negatively," he said.

The study was published online on November 27 in JAMA Internal Medicine .

More information

The American Academy of Family Physicians has more about the doctor / patient relationship.

SOURCES : Anthony Jerant, MD, professor of family and community medicine at the University of California, Davis School of Medicine, Sacramento, California, Cynthia Smith, MD, vice president of clinical programs, American College of Physicians, Joseph Ross , M.D., badociate professor, Yale School of Medicine, New Haven, Connecticut; November 27, 2017, JAMA Internal Medicine online

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