Get Along or Don't Get Better

Patients perceived as 'difficult' are more likely to have worse health outcomes

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Patients who are seen as 'difficult' by their doctors may experience worsening symptoms, according to a study that appears online in the Journal of General Internal Medicine.

Although past studies have examined the health implications of difficult patients, this is the first to factor in both patient and doctor characteristics in assessing what makes a patient difficult and how that might impact the patient's health outcomes.

In order to identify 'difficult' patients, Sheri Hinchey from the Tripler Army Medical Center in Honolulu and Jeffrey Jackson from the Zablock VA Medical Center in Milwaukee studied primary care visits of 750 adults.

Prior to consultation, the researchers gathered information on patients' symptoms, expectations, general health, as well as their physical, social, and emotional functioning. They also looked into patients' history of mental disorders. The patients then were interviewed after the visit. After two weeks, patients' symptoms were checked again, and clinicians were asked to evaluate the difficulty of each visit.

Hinchey and Jackson found that almost 18 percent of patients were seen as 'difficult.' Doctors who practiced more open communication and who had more years of experience reported less difficult encounters. Patients perceived as difficult had more symptoms upon return visit, and used the clinic more often than non-difficult patients. The difficult patients were also more likely to have a mental health disorder and to exhibit worse physical, social, and emotional functioning.

These findings highlight the importance of open communication and dialogue between patient and clinician. The more the patient and clinician relationship is improved, the greater the likelihood of positive health outcomes for patients.

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Review Date: 
January 26, 2011
Last Updated:
January 26, 2011