Poor communicators perceive more 'difficult' patient encounters

Most published research about so-called 'difficult' patients focuses on patient characteristics that lead to their incessant complaints, stubborn symptoms and unreasonable demands on physicians' time and energy. But a new study published in the Journal of General Internal Medicine suggests that physician traits may also play a significant role in creating challenging patient encounters.

For the study, researchers surveyed 750 adults who visited an internal medicine walk-in clinic and their treating physicians. Using a broad definition of 'difficult' that included patients who simply did not get well, 18 percent of the patients seen at the Walter Reed Army Medical Center garnered the label, slightly higher than the 15 percent rate estimated by previous studies.

According to study author Dr. Jeffrey L. Jackson, a professor of medicine at the Medical College of Wisconsin, not all patients deemed 'difficult' fit the mold one would expect. "They're not patients with complex medical conditions," he 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."

Even more telling, however, are the commonalities identified among physicians involved in difficult encounters. According to the results of the physician-completed assessments, physicians who reported difficult encounters--and the accompanying poor outcomes--tended to have less experience and poorer psychosocial orientation than their less-troubled colleagues. And not surprisingly, the physicians' communication skills emerged as a key indicator of a healthy doctor-patient relationship.

"The patients who have these kinds of problems do better with doctors who have a more open, interpersonal style," Jackson said. "This leaves me optimistic that we can do a better job."

To learn more:
- read the HealthDay article in U.S. News & World Report
see the study abstract from the Journal of General Internal Medicine