Discussions with patients about their requested referrals and treatments can be a point of contention, and curiosity-driven exploration of strategies and perceptions is needed to compromise respect for the patient and the clinician’s obligations. This information was reported by Richard L. Kravitz, MD, MSPH, of the University of California – Davis, Sacramento, in a manuscript published Wednesday online in the Journal of the American Medical Association. Clinicians have several discussions about tests, referrals and treatments with patients and their caregivers every day. Patients may request tests or treatments that the clinician may deem inappropriate, not needed or low in value, which can lead to dissatisfaction and confusion. Dr. Kravitz cited a study where 68% of1,319 outpatient visits, among 56 family physicians, had at least one request for a test, referral or medication. Careful management of these requests is necessary in an environment of increasing heath care costs. Previous research recommends three ways to better this communications process: allow patients to express all concerns, respond to and validate patients’ feelings and avoid declaring definitive statements before understanding what the patients are requesting. Due to modern practice methods, clinicians may not have time to address each patient request in-depth, but exploration of patients’ needs and requests can lead to better diagnostic accuracy without increasing the length of the visit. Additionally, a study surveying 211 adult patients showed that patients gave higher ratings to physicians who considered patients’ out-of-pocket costs than total costs. Clinicians should consider out-of-pocket costs for patients during the discussion of patient requests, Dr. Kravitz wrote. “Instead of denying patient requests based on costs or with no explanation at all, clinicians can invoke the strategies of substitution, contingency and availability,” Dr. Kravitz wrote. A patient is also more likely to accept more conservative forms of care if they are assured of follow-up care, if it is needed, when the follow-up care is performed by a clinician who is familiar with the patient’s medical history. Even if it is over a telephone call, this follow-up is important for both the clinician and the patient. Overall, clinician-patient discussions about care should be carefully navigated and clinicians should consider patients’ requests while balancing their clinical obligations. Source: Kravitz RL. Negotiating With Patients About Tests, Referrals, and Treatments. JAMA. 2025 March 19 (Article in Press). Image Credit: Prostock-studio – stock.adobe.com