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In this issue of JAMA Oncology, Gogineni and colleagues report on their empirical inquiry into patient demands,1 a nemesis that proves to be more mythical than real. The study hypothesis—that patient demands for treatments and scans drove unnecessary costs—was spectacularly unconfirmed when using data collected from physicians themselves. Only 8% of the patient-physician encounters at 3 cancer centers in Philadelphia involved a patient “demand,” and the majority of those “demands” were viewed by the physician as “clinically appropriate.” Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth.
In the wake of these findings, the question now deserving of our attention is why does the myth of the demanding patient have so much traction? Surprisingly (as the authors note), no prior empirical study exists to tally patient demands in cancer care, which makes the existence of the demanding patient myth even more curious. My new hypothesis is that these findings say more about our own clinical sensibilities than what they reveal about our patients. We clinicians often, in my own experience, view patients who make a request that is surprising, unjustified, or forceful (eg, a “demand”) as (1) hard to deal with; (2) memorable despite their infrequent appearance; and (3) a convenient target for the bigger, complex, seemingly unsolvable problems we face.
Back AL. The Myth of the Demanding Patient. JAMA Oncol. 2015;1(1):18–19. doi:10.1001/jamaoncol.2014.185
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