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The Prevalence and Characteristics of Difficult Patient Encounters : A Systematic Review and Meta-analysis
Jeffrey L Jackson1, Akira Kuriyama2, Jeff Whittle1
1Clement J. Zablocki Veterans' Administration Medical Center and Medical College of Wisconsin, Milwaukee, Wisconsin (J.L.J., J.W., A.D.-M., M.T., M.G.M., S.G., K.B., C.G., K.E.F.).
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, PsycInfo, 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.
Primary Funding Source:
None. (PROSPERO: CRD42024583715).
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