News release

From: American College of Physicians

Study finds 17% of patients are perceived as difficult by physicians

A systematic review of 45 studies found that physicians perceive one in six patient visits in non-psychiatric clinics as “difficult,” and these encounters are more likely to involve patients with mental health disorders or chronic pain. The analysis also found that less experienced providers report more difficult interactions, and these visits often leave patients less satisfied and with unmet expectations. The review is published in Annals of Internal Medicine.

Researchers from Clement J. Zablocki Veterans’ Administration Medical Center and Medical College of Wisconsin sought to understand how often clinic visits are considered difficult and what factors contribute to these challenging interactions. They conducted a systematic review and analysis of studies of adult patients seen in nonpsychiatric settings that included information on the prevalence, characteristics, or outcomes of patients perceived as difficult or characteristics of the physicians who considered them difficult. The analysis showed that about 17% of patients were perceived as difficult. Patients with depression, anxiety, chronic pain, substance use disorders, or personality disorders were significantly more likely to fall into this category. Providers with fewer years of experience also reported more difficulty. Provider characteristics that increased the prevalence of difficult clinic visits included provider experience, burnout, and job satisfaction. Patients were more likely to leave difficult clinic visits with unmet expectations and lower satisfaction. The findings suggest that improving training for nonpsychiatric physicians so they could better address underlying mental health and pain issues could make visits more productive and positive for both patients and clinicians.

In an accompanying editorial, editorialists discuss how the review has provided an important map of where and with whom difficulty tends to arise and say that the next step is to use that map not to avoid these patients, but to be better prepared for caring for them.