When do Physicians Follow their Patients' Orders?

Several recent developments have converged to place the patient into a more central position in medical decision-making. Yet physicians historically have enjoyed near-complete authority and autonomy in patient care, and the organization of medicine has changed relatively little in response to the demand for a more "patient-centered" approach to clinical care. This paper examines how this strain is played out by evaluating the conditions under which physicians acquiesce to their patients' treatment requests. Using nationally representative survey data from both physicians and patients, we find that patient characteristics such as access to medical information and socioeconomic status did not affect the extent to which physicians incorporate their demands into clinical decision-making. Instead, retention-related concerns appeared to have the strongest effect on physicians' acquiescence. Interestingly, however, it is the perception of competition that drove behavior, rather then the geographic concentration of physicians. We also find indications of intra-professional stratification, with physicians bearing higher prestige levels less likely to accede to patient requests. Implications for patient-doctor relationship and physician practice are discussed in the context of the changing organization of medical care. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]