Doctors report that about one in six patients is “difficult.” In a busy practice, that can mean three or four unpleasant visits with patients each day. But some doctors report more difficulty with patients than others. A study in this week’s Archives of Internal Medicine explores the characteristics of doctors who often complain about their patients. The researchers surveyed 426 physicians from 118 urban and rural clinics in Illinois, Wisconsin and New York. They ranged in age from 29 to 89, 44 percent were women and 22 percent were from a minority or ethnic group. After asking doctors about their experiences with difficult patients, the researchers focused on the 113 doctors in the group who most frequently reported these “difficult encounters.” Those doctors were more likely to be younger and female. And physicians who reported having more difficult patient encounters were 12 times more likely to report “burnout” than those reporting fewer difficult encounters, the study showed. The data suggest that some doctors may simply have a shorter fuse when it comes to dealing with a challenging patient. The researchers noted that older, more experienced practitioners are likely better at dealing with unhappy patients and may be less likely to view patient visits as difficult, even when they’re not perfect. While it’s not clear why female doctors are more likely to report difficult patients, other studies have suggested that female doctors have higher rates of burnout. The study didn’t let patients off the hook for conflict with their doctors. More than one in three doctors in the study said the most frustrating patient is one who insists on being prescribed an unnecessary drug. About 16 percent of doctors said they frequently saw patients who were unhappy with their care. About 14 percent of physicians say they regularly see patients who have unrealistic expectations for their care. An editorial accompanying the study suggested that doctors need better training to cope with the psychological challenges of caring for patients. Doctors also should focus on identifying a patient’s expectations at the beginning of a visit. Reforms that better reimburse doctors for more “talk time” with patients also are needed. Finally, doctors are advised to rise to the challenge of working with a difficult patient. Dealing with difficulty signifies mastery rather than weakness. Olympic dives are rated in terms of difficulty, as are mountain climbs, hiking trails, musical works, crossword puzzles and highly technical procedures. Partnering with patients in the challenging aspects of their health, lives or medical care is a stepping stone to surmounting together the difficult encounter. Source
