Blog | Monday, February 7, 2011

QD: News Every Day--'Difficult' patients


Physicians see nearly one in five patients as "difficult," report researchers. Not surprisingly, these patients don't fare as well as others after visiting their doctor.

Researchers took into account both patient and clinician factors associated with being considered 'difficult', as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine.

Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and their levels of trust in their doctor. Two weeks later, researchers checked symptoms again.

Also, clinicians were asked to rate how difficult the encounter was after each visit. Nearly 18% were "difficult." They had more symptoms, worse functional status, used the clinic more frequently and were more likely to have an underlying psychiatric disorder than non-difficult patients. These patients were less satisfied, trusted their physicians less and had a greater number of unmet expectations. Two weeks later, they were also more likely to experience worsening of their symptoms.

But the label works both ways, as physicians with a more open communication style and those with more experience reported fewer difficult encounters, researchers said.

On a lighter note, TV's comedy "Seinfeld" dedicated an entire plotline from one of its many episodes to Elaine, her doctor, and the label of being a difficult patient. It's worth watching here.