Difficult patients: exploring the patient perspective

Patients experienced as difficult comprise at least 15% of ambulatory visits. To better understand these challenging relationships, we explored the patients' perspectives about their relationships with their doctors.

Using a cross-sectional study design, we surveyed patients regarding their perception of their doctor-patient relationship using five questions graded on a 7-point Likert scale. Family medicine residents subjectively determined which of their patients were "difficult." This patient "difficulty" status was linked to the patient survey's data through anonymous coding.

A total of 161 patients participated, for a response rate of 60%. Of these patients, 20% were perceived as difficult. Two sample t test comparison of means revealed that difficult patients reported greater ease in communication. After adjusting for demographics and individual characteristics, Generalized Linear Model (GLM) uncovered that men reported a harder time talking with their doctor, thought their problems were more challenging, and felt less in control of their health care decisions. Gender was a stronger predictor than perceived difficult status for patients' perceptions of poorer quality relationships with providers.

Surprisingly, difficult patients overall reported greater ease of communication with their residents than non-difficult patients. The pronounced discordance between the perspectives of physicians and patients likely underlies much of the frustration experienced by clinicians. Since difficult patients seem satisfied with the resident-patient relationship, further work is needed to understand this discrepancy and improve physician ease and satisfaction with these challenging relationships.