Strategies Assist Doctors in Saying 'No' to Patients

Patient-oriented denials of prescription requests linked to greater satisfaction with visit

TUESDAY, Feb. 23 (HealthDay News) -- When primary care physicians need to deny patient requests for tests and treatments, strategies that incorporate the patient perspective may be most effective, according to a study in the Feb. 22 issue of the Archives of Internal Medicine.

Debora A. Paterniti, Ph.D., of the University of California, Davis, in Sacramento, and colleagues analyzed data from the audio-recorded standardized patient visits and post-visit questionnaires of 84 patients who were denied a request for antidepressants.

During 53 visits (63 percent), the researchers found that physicians used at least one of three strategies that incorporated the patient perspective: exploring the context of the request, referring to a mental health professional, and offering an alternative diagnosis. They also found that physicians emphasized biomedical approaches such prescribing a sleep aid or ordering a diagnostic workup in 26 visits (31 percent), and denied the request outright in five visits (6 percent). Their analysis of post-visit questionnaires showed significantly higher satisfaction in patients whose requests were denied with approaches relying on the patient perspective.

"Strategies for saying no may be used to communicate appropriate care plans, to reduce provision of medically inappropriate services, and to preserve the physician-patient relationship," the authors conclude. "These findings should be considered in the context of physician education and training in light of increasing health care costs."

One author reported a financial relationship with Pfizer.

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