(February 22, 2010 - Insidermedicine)

Patients are most likely to accept a "no" to a request for a specific medication from their doctor if that doctor is sympathetic to the patient's perspective, according to research published in the the Archives of Internal Medicine.

Here are some recommendations for enhancing doctor-patient communication, from the University of Michigan:

•    Know who the patient is before greeting him or her in your office

•    Make eye contact with the patient, shake hands, and introduce yourself

•    Give the patient time to tell his or her story.

Researchers out of University of California, Davis in Sacramento analyzed audio transcripts of standardized patient visits to 152 randomly selected primary care physicians in 2003 and 2004. During the study period, 18 insured, middle-aged white women were trained to pose as patients complaining of subacute insomnia and fatigue in addition to symptoms suggestive of lower back strain or carpal tunnel syndrome and requesting antidepressant medication.

Out of 199 standardized patient visits in which antidepressants were requested, prescriptions were not given 44% of the time. Overall, 63% of physicians denied the request using one of three strategies: exploring the context of the request, referring to a mental health professional, or offering an alternative diagnosis. A biomedical approach to the problem, such as ordering a diagnostic workup or prescribing sleep aids, was taken 31% of the time, and 6% of physicians denied the request outright. Patients were most satisfied with the visit when physicians took an approach that relied on the patient's perspective.

Today's research suggests strategies for denying patient requests for treatment that is deemed inappropriate without damaging the doctor-patient relationship.