Clinically Inappropriate Patient Demands of Oncologists Happen More Infrequently Than Expected

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Ezekiel J. Emanuel, MD, PhD

A new study1 conducted at outpatient oncology centers found that only 1% of 5,050 patient-clinician encounters resulted in a clinically inappropriate request, of which very few were complied with by physicians.

Ezekiel J. Emanuel, MD, PhD, of the University of Pennsylvania, and colleagues analyzed interviews with clinicians immediately after they visited with patients to assess whether a patient had made a demand, the type of request made, and the clinical appropriateness of it. The interviews were conducted at outpatient oncology facilities at three Philadelphia-area hospitals between October 2013 and June 2014.

The authors evaluated 5,050 patient-clinician encounters involving 3,624 patients and 60 clinicians. Most of the patients were women, and the most common cancer was hematologic.

Overall, 440 (8.7%) of the 5,050 encounters included a patient demand or request, such as for imaging studies, treatments, or tests, and physicians complied with 365 (83%) of them. Of all 5,050 patient-clinician encounters, 316 (6.3%) had a clinically appropriate patient demand or request, whereas only 50 (1%) of the encounters had a clinically inappropriate request. Of the 50 clinically inappropriate demands or requests, clinicians complied with 7 of them, which means that in just 0.14% of encounters (7 of 5,050) did clinicians order a test or treatment based on a clinically inappropriate request.

“At least in oncology, ‘demanding patients’ seem infrequent and may not account for a significant proportion of costs,” the study concludes.

The Myth of the Demanding Patient

In a related editorial,2 Anthony L. Back, MD, of the Seattle Cancer Care Alliance, said, “Dr. Gogineni and colleagues report on their empirical inquiry into patient demands, a nemesis that proves to be more mythical than real. The real point of the study, however, is this: We have to stop blaming patients for being demanding. In reality, it is hardly happening. The myth of the demanding patient is more about our own responses and lackluster communication skills.”

Dr. Back continued, “It is possible that what the study documents is a point in the evolution of the patient-physician relationship when both sides recognize the complexity of cancer care belies a simple fix.” ■


1. Gogineni K, Shuman KL, Chinn D, et al: Patient demands and requests for cancer tests and treatments. JAMA Oncol. February 12, 2015 (early release online).

2. Back AL: The myth of the demanding patient. JAMA Oncol. February 12, 2015 (early release online).