Despite the commonly held notion that patient demand drives doctors to perform unnecessary tests and procedures, new research indicates this may not be the case at all.
In a study published in JAMA Oncology, clinicians at outpatient oncology facilities at three Philadelphia-area hospitals were asked immediately after patient visits between October 2013 and June 2014 whether the patients made a demand or request regarding their care. They also were asked to describe the type of request and its appropriateness for treatment, as well as indicate whether they complied with the request.
Out of 5,050 patient-clinician interactions at the facilities, only 440 cases--8.7 percent--involved a patient request for medical intervention, the study found. In the cases that involved a demand, clinicians complied 83 percent of the time with the patient's request, and they complied 14 percent of the time even when they deemed the request medically inappropriate. But when considering all 5,050 interactions, patients made clinically inappropriate requests in only 1 percent of encounters, and they were granted only .14 percent of the time.
The study's findings suggest to clinicians that "we have to stop blaming patients for being demanding," Anthony L. Back, M.D., wrote in an accompanying JAMA opinion piece. "In reality, it is hardly happening. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories."
Indeed, physicians are increasingly being evaluated for their communication and social skills, with some medical schools even teaching and testing specific skills that will allow doctors-in-training to better partner with patients, FiercePracticeManagement has reported. A recent Consumer Reports survey also connected feelings of respect between provider and patient with improved quality of care and fewer medical errors.
But while patient demands may not be the culprit behind it, unnecessary care remains of the biggest drivers of spiraling healthcare costs. In fact, one survey found that 75 percent of doctors think their colleagues order at least one unnecessary test or procedure a week, FierceHealthcare reported.
Thus, more research is needed to truly determine what's driving unnecessary care, Jason Doctor, an associate professor at the University of Southern California's School of Pharmacy, who is not connected to the study, told Kaiser Health News.
"People should study this through," he said. "Then we can understand whether we should do supply-side intervention or demand-side interventions to reduce inappropriate treatment."
To learn more:
- check out the study
- here's the opinion piece
- read the Kaiser Health News article