After adjustment for patient medical and psychiatric complexity , perceived difficulty was significantly higher when patients requested diagnostic tests [ parameter estimate ( PE ) 0.11 , ( 95 % CI : 0.03 , 0.20 ) ] but not when patients requested pain medications [ PE -0.04 ( 95 % CI : -0.15 , 0.08 ) ] or referrals [ PE 0.04 ( 95 % CI : -0.07 , 0.25 ) ] .