What is a difficult patient, and how doctors may be responsible

What, exactly, is a difficult patient?

Doctors can tell many tales of what they term as a difficult encounter.  Just as many patients can recall doctors whom they would say are difficult to work with as well.

According to a study from the Journal of General Internal Medicine, here’s a definition:

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.

It’s important to note that patients weren’t the only responsibly party to the difficult encounter.  Physicians play a role in this as well.

As such,

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,” [study co-author] Dr. Jackson said.

There will always be patients with multiple medical problems, or psychiatric disorders that will make the encounter more challenging. But it depends on a physician’s psychosocial experience whether that encounter will traverse into the realm of “difficult.” Of course, that experience comes with time.

Perhaps more training during residency is needed on how to deal with complex patient interactions is needed, so that new doctors would be more comfortable in handling a broader spectrum of patients.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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