What happens when patients say “no” to offers of referral for weight loss? - Results and recommendations from a conversation analysis of primary care interactions

Abstract Objective Guidelines recommend that clinicians should offer patients with obesity referrals to weight management services. However, clinicians and patients worry that such conversations will generate friction, and the risk of this is greatest when patients say no. We examined how doctors actually respond to patient refusals, and how patients reacted to clinicians in turn. Methods Conversation analysis of 226 GP-patient interactions recorded during a clinical trial of weight management referrals in UK primary care. Results Some clinicians responded to refusals by delivering further information or offering referral again. These actions treated patient refusals as unwelcome, and acted to pursue acceptance instead. However, pursuit did not lead to acceptance. Rather, pursuing acceptance lengthened consultations and led to frustration, offence, or anger. Clinicians who accepted refusals and closed the consultation avoided friction and negative emotional displays. Conclusion Patient refusals have the potential to create negative consequences in the consultation and clinician responses were key in avoiding these. When clinicians acknowledged the legitimacy of patient refusals, negative consequences were avoided, and the conversation was briefer and smoother. Practice Implications When patients refuse the offer of a free weight management referral, GPs should accept this refusal, rather than trying to persuade patients to accept.