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The difficult inpatient, prevalence and characteristics.

Jeffrey L Jackson1, Mary G Murphy2, Kathlyn E Fletcher2

  • 1Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki VAMC, Milwaukee, WI, USA.

Patient Education and Counseling
|May 1, 2025
PubMed
Summary

Approximately 24.5% of hospitalized medicine patients are perceived as difficult by providers. Chronic pain and personality disorders were independently associated with increased difficulty ratings, highlighting key patient characteristics.

Keywords:
DifficultyHospitalistsPatient-provider communication

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Area of Science:

  • Medical Education
  • Patient-Provider Communication
  • Healthcare Management

Background:

  • A significant percentage of ambulatory patients are perceived as difficult by primary care providers.
  • Qualitative studies suggest hospitalized patients are also frequently perceived as difficult by inpatient providers.
  • Quantitative data on the prevalence of difficult hospitalized patients is lacking.

Purpose of the Study:

  • To quantify the prevalence of hospitalized patients perceived as difficult by medicine providers.
  • To identify patient characteristics associated with being perceived as difficult.

Main Methods:

  • A quantitative study involving surveys of inpatient medicine providers assessing patient difficulty.
  • Difficulty was measured using dichotomous and continuous scales.
  • Patient data including demographics, cognitive status, comorbidities, and specific diagnoses were extracted from charts.

Main Results:

  • Surveys from 322 unique inpatients revealed 24.5% were perceived as difficult.
  • No association was found between age, general mental health comorbidities, or medical complexity and perceived difficulty.
  • Multivariate analysis identified personality disorders (OR: 5.4) and chronic pain (OR: 2.1) as independent predictors of perceived difficulty.

Conclusions:

  • Hospitalized medicine patients are frequently perceived as difficult by their providers.
  • Chronic pain and personality disorders significantly increase the likelihood of a patient being perceived as difficult.
  • Findings suggest focusing on these specific patient characteristics may improve provider-patient interactions.