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Docs Rate Almost 1 in 5 Patients as 'Difficult': Study
Date:1/29/2011

By Randy Dotinga
HealthDay Reporter

FRIDAY, Jan. 28 (HealthDay News) -- A new study finds that about 18 percent of patients are considered difficult, and they're more likely than others to stay sick.

However, they're only part of the equation: Researchers also report that older doctors and those with better communication skills aren't as flummoxed by difficult patients.

"The patients who have these kinds of problems do better with doctors who have a more open, interpersonal style," said study author Dr. Jeffrey L. Jackson, a professor of medicine at the Medical College of Wisconsin. "This leaves me optimistic that we can do a better job."

Some people may assume that a "difficult patient" is someone who's a pain in the neck to deal with on a personal level. But the definition in the study is a bit more wide-ranging: it also includes patients who don't get well. For instance, "a patient who has lots of physical complaints, but no matter how hard you look you can't find a biological explanation. They keep coming back week after week, month after month," Jackson explained.

In the study, researchers surveyed 750 adults who visited an internal medicine walk-in clinic at Walter Reed Army Medical Center. They also surveyed physicians who treated the patients and found that about 18 percent qualified as being difficult.

Who were they? "They're not patients with complex medical conditions," Jackson said. "It's patients with lots of unexplained physical symptoms, lots of stress, extremes of pain and discomfort. There's a smidgen who have anxiety and depression disorders."

The findings tie in with previous research that suggests about 15 percent of patients are "difficult," Jackson said. Difficult patients were 2.4 times more likely to have worse symptoms two weeks after their visit and to report that their expectations weren't met.

The researchers also found that physicians with fewer than 10 years of experience reported that almost one in four patient visits were difficult, while those with 20 or more years of experience ranked the number as just 2 percent.

Dr. Tony Miksanek, a family physician in the small Illinois town of Benton, said the number of difficult patients in the study seems too high. He questioned whether the study's numbers are reliable because they're based on surveys instead of in-person observations of patient-doctor interactions.

In his own practice, he ranks the number of difficult patients at about 1 percent. They include those who "are looking for your input and your advice, and then they just don't do it. But they keep coming back," he said. There are also those who "come in with a laundry list of 20 complaints and want you to address and hopefully heal all of those," Miksanek said.

"There are also those with personality issues who are almost looking to pick a fight with the doctor. In all fairness, the opposite side of the equation is the patient's assessment of their physician. We're not all Marcus Welby, either," he added.

"The patient has to be their own advocate," Miksanek said. "If the doctor is just going to shoo them in and out of the office, that's a difficult doctor. The patient has to have respect and faith and trust in the physician, and sometimes doctors don't provide that to them."

The findings were published online Jan. 26 in the Journal of General Internal Medicine.

More information

The U.S. National Library of Medicine has details about dealing with your doctor.

SOURCES: Jeffrey L. Jackson, M.D., professor, medicine, Medical College of Wisconsin, Milwaukee; Tony Miksanek, M.D., family physician, Benton, Ill.; Jan. 26, 2011, Journal of General Internal Medicine, online


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