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Research ArticleOriginal Research

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

Elizabeth M. Magnan, Peter Franks, Anthony Jerant, Richard L. Kravitz and Joshua J. Fenton
The Journal of the American Board of Family Medicine January 2020, 33 (1) 51-58; DOI: https://doi.org/10.3122/jabfm.2020.01.190202
Elizabeth M. Magnan
the Department of Family and Community Medicine (EMM, PF, AJ, JJF), the Center for Healthcare Policy and Research (EMM, PF, AJ, RLK, JJF), and the Division of General Medicine, Department of Internal Medicine (RLK), University of California, Davis Medical Center, Sacramento, CA.
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Peter Franks
the Department of Family and Community Medicine (EMM, PF, AJ, JJF), the Center for Healthcare Policy and Research (EMM, PF, AJ, RLK, JJF), and the Division of General Medicine, Department of Internal Medicine (RLK), University of California, Davis Medical Center, Sacramento, CA.
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Anthony Jerant
the Department of Family and Community Medicine (EMM, PF, AJ, JJF), the Center for Healthcare Policy and Research (EMM, PF, AJ, RLK, JJF), and the Division of General Medicine, Department of Internal Medicine (RLK), University of California, Davis Medical Center, Sacramento, CA.
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Richard L. Kravitz
the Department of Family and Community Medicine (EMM, PF, AJ, JJF), the Center for Healthcare Policy and Research (EMM, PF, AJ, RLK, JJF), and the Division of General Medicine, Department of Internal Medicine (RLK), University of California, Davis Medical Center, Sacramento, CA.
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Joshua J. Fenton
the Department of Family and Community Medicine (EMM, PF, AJ, JJF), the Center for Healthcare Policy and Research (EMM, PF, AJ, RLK, JJF), and the Division of General Medicine, Department of Internal Medicine (RLK), University of California, Davis Medical Center, Sacramento, CA.
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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.

  • Cross-Sectional Studies
  • Outpatients
  • Patient Satisfaction
  • Personal Satisfaction
  • Physician-Patient Relations
  • Primary Care Physicians
  • Regression Analysis
  • Self Report
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The Journal of the American Board of Family     Medicine: 33 (1)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 1
January-February 2020
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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
The Journal of the American Board of Family Medicine Jan 2020, 33 (1) 51-58; DOI: 10.3122/jabfm.2020.01.190202

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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
The Journal of the American Board of Family Medicine Jan 2020, 33 (1) 51-58; DOI: 10.3122/jabfm.2020.01.190202
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Keywords

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

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