In nonpsychiatric settings, primary care physicians consider 17% of their patients as “difficult,” particularly those who have anxiety or depression, according to research published Jan. 12 in Annals of Internal Medicine.
Researchers at Clement J. Zablocki Veterans’ Administration Medical Center and Medical College of Wisconsin, both based in Milwaukee, reviewed studies that included marking patients as “difficult.” Fourteen studies analyzed the prevalence of difficult patient encounters and another 20 assessed the correlation between difficulty and patient/provider characteristics or patient outcomes.
There was insufficient evidence to determine whether being seen as difficult was tied to worse health outcomes. However, patients seen as difficult were more likely to report unmet expectations after the visit and less likely to be satisfied with their provider.
A patient’s age was not associated with a physician’s perception of being difficult, the study found. However, the patient characteristics that physicians were likely to perceive as difficult included having depression, anxiety, chronic pain or a personality disorder. Women were also more likely to be seen as difficult compared to men.
Among physicians, residents were more likely than other physicians with more experience to report patients as being difficult. The analysis also found a correlation between experiencing burnout and perceiving patients as difficult, as well as lower job satisfaction.
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