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Comment & Response
July 2015

The Demanding Patient Revisited—Reply

Author Affiliations
  • 1Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
  • 2Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
  • 3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 4The Wharton School, Department of Health Care Management, University of Pennsylvania, Philadelphia
JAMA Oncol. 2015;1(4):544. doi:10.1001/jamaoncol.2015.1111

In Reply If the aim is to assess how much patients drive health care costs, then it is clinicians’ perspectives on whether a patient requested or demanded a test or treatment that is the right one. After all, the key issue is whether clinicians perceive what patients said as requests. It does not matter whether a researcher examining tapes has a different impression. Only clinicians can order tests or treatments and drive health care costs.

To check for faulty memory, we did assess whether clinicians who were asked immediately after they left the examination room reported a different rate of patient requests or demands for treatment compared with clinicians interviewed at the end of a clinic session. We found no difference in the rate of patient demands or requests. This is probably in part because a patient demand or request is salient and, thus, memorable.

Finally, given the high stakes of cancer treatment and the extensive information available from support groups, the Internet, and other media, we suspected that patients with cancer would be more vigilant and engaged and likely to demand or request treatments more frequently than other patient groups. But this is an empirical question that can only be answered by surveying thousands of clinical encounters in primary care and other specialties. We readily acknowledged that a sample of oncology patients from Philadelphia may not be representative and that additional studies are needed to confirm our findings.

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Article Information

Corresponding Author: Ezekiel J. Emanuel, MD, PhD, The Wharton School, Department of Health Care Management, University of Pennsylvania, 122 College Hall, Philadelphia, PA 19104-6303 (zemanuel@upenn.edu).

Published Online: May 28, 2015. doi:10.1001/jamaoncol.2015.1111.

Conflict of Interest Disclosures: None reported.

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