Clearly, not fulfilling patients' requests diminishes their satisfaction, but patient-centered communication can enhance that. So what is one to do?

Being adept at saying "no" is an art; it should preserve, if not amplify a practitioners' interest in and concern for their patient. This article describes ways of negotiating with patients about specific requests for diagnostic testing, treatment, on-going or changing care.

Conclusions "Strategies for saying no may be used to communicate appropriate care plans, to reduce provision of medically inappropriate services, and to preserve the physician-patient relationship. These findings should be considered in the context of physician education and training in light of increasing health care costs."

Paterniti DA, Fancher TL, Cipri CS, Timmermans S, Heritage J, Kravitz RL. "Getting to 'No': Strategies Primary Care Physicians Use to Deny Patient Requests." Arch Intern Med. 2010;170(4):381-388