The Prevalence and Characteristics of Difficult Patient Encounters: A Systematic Review and Meta-analysis, 2025, Jackson et al

[rvallee]

The Prevalence and Characteristics of Difficult Patient Encounters: A Systematic Review and Meta-analysis
Annals of Internal Medicine: https://doi.org/10.7326/ANNALS-25-01882
Paywalled: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01882

Abstract​

Background:​

Patients are sometimes experienced as difficult by their providers.

Purpose:​

To estimate the prevalence of difficult patient encounters among adults being seen in nonpsychiatric settings. Secondary goals were to assess patient and provider characteristics associated with difficulty as well as patient outcomes.

Data Sources:​

MEDLINE, Web of Science, SciELO, ProQuest, Theses, Scopus, PsychInfo, Cochrane Central Register of Controlled Trials, Global Index Medicus, and EMBASE (inception through 7 July 2025).

Study Selection:​

In duplicate and independently.

Data Extraction:​

Prevalence, patient characteristics (sex, mental health diagnosis, somatization, personality disorders, and chronic pain), provider characteristics (type of provider, encounter setting, burnout, years of experience, and sex), and encounter outcomes (patient unmet expectations and satisfaction) were extracted in duplicate.

Data Synthesis:​

The prevalence of difficult encounters among clinic patients was 0.17 (95% CI, 0.15 to 0.19). Patient characteristics that increased difficulty included personality disorders (relative risk [RR], 2.2 [CI, 1.5 to 3.1]), depression (RR, 1.9 [CI, 1.7 to 2.2]), anxiety (RR, 2.1 [CI, 1.7 to 2.6]), and chronic pain (RR, 1.9 [CI, 1.5 to 2.4]). Providers with less experience (weighted mean difference, −3.5 years [CI, −5.0 to −1.9 years]) rated more encounters as difficult. Patients perceived as difficult were more likely to have unmet visit expectations (RR, 1.9 [CI, 1.4 to 2.5]) and lower satisfaction (RR, 0.76 [CI, 0.65 to 0.88]).

Limitation:​

Limited data and heterogeneity for many secondary analyses.

Conclusion:​

Providers perceived 17% of clinic patients as difficult. Patients perceived as difficult were more likely to have depression, anxiety, a greater number of symptoms, personality disorders, or chronic pain. Less experienced providers were more likely to judge patients as difficult. Patients from difficult encounters had more unmet visit expectations and less satisfaction.

 

[rvallee]

Hard to confirm since it's paywalled, but from abstract it seems to follow the pattern we are used to, and is directly related to outcomes. Patients want good outcomes. Physicians want good outcomes. Both patients and physicians are satisfied with good outcomes, and dissatisfied with bad outcomes. This is about bad outcomes where medicine is ineffectual.

The standard response to bad outcomes on the part of medicine seems to be all about making those outcomes worse, by shunning the patients, relying on failing psychosomatic models that make it impossible to improve those outcomes because they provide false claims that it's the patients' fault, hence the framing of 'difficult patients'. It's not the patients who are difficult, it's the problems that face us and medicine's ineptitude at producing better outcomes.

This ultimately seems to be about 99% of the problem with us, it's a reaction to failure and uncertainty, throwing out all the babies that are left in the dirty bathwater. It's so obvious and blatant for anyone looking at it soberly, without ideological beer goggles.

Psychosomatic ideology only worsens those outcomes, but it's the preferred way of dealing with them. Everyone is unhappy, but it's impossible to change anything because the solution from those who control the system is always more of the failure. This has been ongoing for decades, and seems unlikely to be fixed any time soon.

 

[SNT Gatchaman]

Primary care patients with mental health disorders, such as depression, anxiety, personality disorders, and substance use disorders, and patients with chronic pain were experienced as more difficult. Primary care patients report feeling inadequately trained to manage these problems.

That error is inadvertently accurate. The patient does indeed have to do a lot of the training the HCP hasn't/can't/won't in order to manage their own condition.

Patients with medically unexplained symptoms have been reported to be a common source of frustration for their providers. These patients commonly report poor functional status, higher symptom burden, and higher health care use. Primary consultative services focused on managing patients with medically unexplained symptoms had a higher prevalence of difficult patients. All included studies suggest that patients with somatization, poor functional status, or high health care use were more likely to be experienced as difficult, but the results were too heterogeneous to pool. Many provider interventions, focused on improving patient–provider communication, have been found to reduce provider frustration among patients with medically unexplained symptoms.

In conclusion, we found that physicians rate 1 in 6 of the patients they treat as difficult but not because they have more medical problems. Rather, patients considered difficult were more likely to have chronic pain, personality disorders, and mental health disorders - chronic problems for which nonpsychiatric physicians often have limited training and few efficacious treatments. Although it is reassuring that these patients have not reported worse outcomes, it is important to provide physicians with skills to address their needs. We suspect the ability to successfully treat these patients might change physician’s perception of them from “difficult” to “rewarding.”

As @rvallee has frequently noted, the patients would like treatments and the HCPs would like to successfully treat their patients. But none of that can happen unless the work is done.

 

[Sean]

Well imagine how sick patients feel when endlessly confronted with doctors with this kind of attitude, who simply cannot say 'we don't know what is wrong or how to treat it', and instead insist on imposing non-diagnoses and non-treatments, and blaming it all on the patient when it inevitably doesn't work.

Do these clowns ever look in a mirror?

 

[BrightCandle]

So this is an admission the are failing 1 in every 6 patients with this ideology and once again it's the patients that are difficult not the healthcare system that is failing them?!