Physicians rate nearly 18% of patients as "difficult"

A new study finds that less experienced doctors and those with fewer psychosocial skills contribute to problematic encounters.

By Carolyne Krupa — Posted Feb. 18, 2011

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Most physicians have experienced difficult patients who have a variety of symptoms, are unresponsive to treatment or are generally uncooperative.

A new study found that physicians at a primary care walk-in clinic rated nearly 18% of patients as difficult. But researchers found that difficult encounters can't be attributed entirely to patients -- physician characteristics also contribute, according to the study published online Jan. 25 in the Journal of General Internal Medicine (link).

Researchers surveyed 750 adult patients and the 38 physicians who treated them at a clinic at Walter Reed Army Medical Center in Washington, D.C., from 2005 to 2007.

Patients were surveyed when they arrived, as they were leaving and two weeks after their visit, said Jeffrey L. Jackson, MD, MPH, study co-author and director of the general medicine section at the Clement J. Zablocki Veterans Affairs Medical Center in Milwaukee. Physicians were evaluated for their psychosocial interaction and filled out a questionnaire after each patient visit.

Doctors rated about 18% of the patients as difficult. The findings are in line with past studies showing that about 15% of patient encounters are rated as difficult, said Dr. Jackson, a professor at the Medical College of Wisconsin.

Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These patients were less likely to fully trust or be satisfied with their physician, and they were more likely to report a worsening of symptoms two weeks after their visit.

Researchers found that physicians who were involved in difficult encounters generally tended to have less experience and fewer psychosocial skills. "When you have someone who has 15 to 20 years of experience, they have learned how to deal with these patients," Dr. Jackson said.

He advises physicians to accept that they will have difficult encounters with patients and learn how to cope with such patients. Some medical schools teach students how to handle challenging patients, and training programs help practicing physicians improve their psychosocial skills.

"Physicians can learn to better manage these patients," Dr. Jackson said.

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