Difficult patients: exploring the patient perspective

Fam Med. 2014 May;46(5):335-9.


Background and objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Communication*
  • Cross-Sectional Studies
  • Family Practice*
  • Female
  • Health Care Surveys
  • Humans
  • Internship and Residency
  • Male
  • Patient Satisfaction*
  • Physician-Patient Relations*
  • Sex Factors
  • Socioeconomic Factors