Physician characteristics, difficult patient encounters linked

When a physician has a "difficult" encounter with a patient, he or she is apt to attribute the problem to particular characteristics of the patient. However, a new study demonstrates that not only patient characteristics are associated with "difficult" encounters; certain physician factors also predict a difficult interaction.

Investigators surveyed adult patients 3 times at a primary care walk-in clinic: before they were seen by clinicians, after their visits with practitioners, and 2 weeks later. Surveys assessed symptom characteristics and outcome, expectations, satisfaction, functional status, and the presence of mental disorders. After each visit, the 38 doctors who saw the participants rated the difficulty of the encounters and also completed a measure of their orientation toward dealing with the psychosocial aspects of medicine-the Physician Belief Scale.

Physicians termed about 18% of the 750 patients they saw as "difficult." Compared with other patients, those considered "difficult" were more likely to have more symptoms and symptoms of greater severity, worse functional status, and an underlying psychiatric disorder. These patients also were less likely to fully trust or be satisfied with their physicians and also were more likely to report worsening symptoms within 2 weeks after their visits and to use more healthcare services.

Hinchey SA, Jackson JL. A cohort study assessing difficult patient encounters in a walk-in primary care clinic, predictors and outcomes. J Gen Intern Med. January 25, 2011. Epub ahead of print.

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