Recently, KevinMD.com picked up my post on empathy or should I say the lack of it.  I received some engaging comments.

One comment in particular caught my attention.

The contributor for some reason equated “being empathetic” with “giving in” to patient requests presumably during routine office visits.  Here’s a direct quote:

Give the patients what they want! Antibiotics are OK for colds. The patients want them. So what if narcotic-addicted patients get more pain medication. That’s what they want. Why make a big deal about a patient’s weight or a patient’s smoking habits? It will upset them.

It then struck me that I hear variations on this theme quite often from physicians.   I interpret this to mean that some physicians are afraid that saying no to a patient request may negatively impact their patient satisfaction scores.   I can see why one would be concerned about this issue so I did a little research to see where the truth lay.

First of all, patient requests are not uncommon.  For example, a sample of 200 patients (closed panel HMO) generated 256 requests for service, like medications, tests, and specialty referrals.  Treating physicians complied with most frequently with patient requests for medications (75.6%) and tests (71.4%) more frequently than expectations for referrals (40.8%).  So what was the impact of these physicians “saying no” figuratively and literally on patient satisfaction and patient trust?  Nothing. Patient satisfaction and trust in their physician remained high regardless of whether patient expectations were met or not.

When patients make requests, I really wonder what they are asking for.   Do they really want or need that antidepressant which they ask for by name, or do they just want their physician to listen to them; yes even empathize with them?

After all, the number one complaint of patients is that their doctors don’t listen to them.  Do patients make requests because they worry that their doctor is too busy to notice a problem like anxiety or depression?  I suspect that negotiating patient requests is not a big concern in physician practices characterized by strong patient-physician relationships and high quality physician-patient communications.

I could be wrong … what do you think?

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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