Many doctors get frustrated with patients whom they consider to be difficult – and some doctors have a harder time than others as they try to deal with these encounters, a study has found.
The article, and an accompanying editorial, appeared earlier this month in the Archives of Internal Medicine.
The researchers surveyed 426 physicians at 118 clinics in Wisconsin, Illinois and New York. Then they focused on the 113 doctors in the group who reported the highest number of difficult encounters with patients. Among the findings: Doctors who reported seeing many difficult patients were more likely to be younger and female, and they also were more likely to report feeling burned out.
It’s hard to know what to make of these conclusions and what they suggest about the complexity of the interaction between doctors and patients.
Do female doctors tend to react more personally when a patient frustrates or upsets them? Do difficult patients gravitate for some reason toward female doctors? Are women doctors more likely to experience sexism or subtle disrespect from patients? Are younger physicians more likely to see difficult patients because their older colleagues have learned how to successfully avoid these patients? Do younger doctors have fewer skills for managing patients they perceive as difficult? Did the doctors in the sample feel burned out because they saw larger numbers of difficult patients, or were the encounters difficult because the doctor was burned out? Perhaps the sample size – 113 doctors, after all – is simply too small to draw any meaningful conclusions.
What’s most intriguing about the study, however, is how common it is for doctors to deal with patients whom they would rather not see.
Physicians report that they secretly hope that their challenging patients will not return and find that, in general, difficult encounters are time-consuming and personally and professionally unsatisfying.
Other studies have estimated that about one out of every six patient visits will wind up being difficult.
Patients who are most often perceived as difficult include those with mental disorders, with long lists of complaints, with a past history of high use of health care services, or aggressive or abrasive personalities. Demanding individuals, such as those who insist on a particular test or prescription medication, also tended to test the doctor’s patience. So did patients who ignored the doctor’s advice and recommendations.
It’s an issue on both sides of the stethoscope, because the evidence suggests that when the relationship doesn’t go well, the patient is less likely to receive the best level of care.
The editorial in the Archives of Internal Medicine recommends better training for physicians in how to deal with challenging patients. This might mean addressing the patient’s expectations more clearly at the beginning of the visit, or taking more time to identify unmet needs.
It’s "all about how doctors and patients relate to one another," a family physician writes in an essay that appeared last year in Health Affairs. "And the problem with a difficult patient isn’t just the patient. It’s also the doctor. Difficult patients and their frustrated physicians fail each other."