MONDAY, Feb. 23, 2009 (Health.com) — Erin Krebs, MD, once had a patient who spent the first eight minutes of his appointment telling her everything that was wrong with the past four primary care doctors he’d seen—including one she knew personally and considers a “lovely person.” “We know that doctors are not perfect,” said Dr. Krebs, an assistant professor at the Indiana University School of Medicine. “But it’s not a good start to spend a lot of time complaining about the past.”
Getting off to a bad start is not at all unusual in the doctor’s office; physicians say they have a “difficult” encounter with one in every six patients.
Now a new survey suggests that the number-one trait that most annoys doctors is a patient who insists on a prescription for a medication he or she doesn’t need. But the survey, published Monday in the Archives of Internal Medicine, also shows that some docs—particularly those who are stressed or burned out—find patients more irritating than others do.
Perry An, MD, of Newton-Wellesley Hospital in Newton, Mass., and colleagues found that these doctors were less satisfied with their work, more pressed for time, and admittedly more likely to make mistakes.
“It’s not just that there are difficult patients or there are difficult doctors. Maybe there are fits that aren’t so great between the two,” said Dr. Krebs, who coauthored a 2006 study on the characteristics of physicians who report being frustrated with patients called “The Difficult Doctor.”
In the current study, the researchers surveyed 422 primary-care doctors practicing across the United States about how often they experienced eight different types of difficult encounters, from having a patient with unrealistic expectations for care to one who was disrespectful or verbally abusive. Doctors fell into three clusters based on how often they reported such difficulties, with 27% having a high number of difficult encounters, 63% a medium number, and 10% a low number.
The most common challenge doctors reported was “patients who insist on being prescribed an unnecessary drug,” with 36.7% saying they encountered such patients frequently. Additionally, 16.1% said they frequently saw patients dissatisfied with their care, and 13.7% said they frequently saw patients who had unrealistic expectations of their care.
Doctors who said they had more troublesome patients tended to be younger, on average, than the other physicians, and they were also more likely to be female.
These “difficult” doctors were 12 times as likely as the low-difficulty doctors to say they were burned out, nearly four times as likely to report high stress, and more than nine times as likely to say they had provided “suboptimal care” in the past year.
Next page: 6 ways to avoid the ‘difficult’ label
Comments (15)
I have worked in hospitals for years and it seems to me that most doctors think they can walk on water. Just my opinion.
RT
http://www.be-anonymous.us.tc
I have worked in hospitals for over 10 years and have a spouse who is a physician. I find that patients have gotten more demanding over time and direct to consumer ads and the internet make people who dont understand how drugs work believe that they are mavens in the field. I dont go to my architect and teach him how to build my house. Why is healthcare that different?
We moved so my wife had to get a new doctor.
It took years to find solutions to her problems, she has been through a battery of testing but eventually she knows what her body responds to and what it doesn’t.
When she sat down with the new doctor (young man) she told him her whole medical history.
Apparently it was a waste of time, because he doesn’t treat her problem that way.
So she did what he suggested, and her normal “cure” which takes effect in days, was cast aside for this new solution which left her sick for another week before things started to get any better.
So… I can walk on water, you try studying for around 15 years and then having to deal with patients who are stubborn and dumb.
You went to school for 15 years and didn’t realize you would be dealing with stubborn and dumb people daily?
Maybe you should have looked at society before going to school for 15 years if you have an issues dealing with people.
One urologist ordered me to arrive for an first appointment fifteen minutes early with a maximally filled bladder. On arrival, I was handed a two sheet list of long questions with small blanks, and asked to rate my symptoms in quintiles for severity without consideration of my unusual medical history for which no room was left on the form. Psychologists tell us that juries are more likely to deliver a death sentence if the courthouse toilets are nasty, and I can imagine that one’s reported symptoms are worse if the “average” rating is made with a painfully distended bladder. Didn’t read the form I filled out, but He spent 2 thirds of the appointment berating me about the answers to the severity questions, never offering me a chance to void or to fully explain. When I terminated the appointment and left, he labeled me a difficult patient. I’m a retired doctor, I know about bad days, and yeah, I guess I’m difficult when I need to pee, but I also know a knife-happy jerk when I meet one.
That’s right. Doctors are the problem. If you have Celiac Disease, then you’ll understand me. I’ve seen five gastroenterologists over the past 5 years who said it was all in my head. They disparaged me. But It turns out – thanks to my PCP – that I had the antibodies to AGA and TTG. I am gluten intolerant. Let’s get rid of the cranky doctors who lie.
My experience is that men and doctors make the worst patients.
On the other hand, since I have some medical experience personally and on the job, I am probably considered difficult. I do not like to be talked down to or given answers to put me off. In my youth doctors, teachers, and lawmen were the most respected people in town. I have lost my respect for doctors in general now and don’t put up with foolishnesss if I know better.
This does not include my present primary doctor nor the doctors at Mayo, but I know they know more than I do and they treat me with respect. They do not have their hand on the door the whole visit as some have done. I know they are busy, but they do not act rushed. Smoothe.
I think the the actions of healthcare professionals can be linked to the facility and the healthcare system in which they work. I have debated this frequently. If you work for a facility that keeps staffing to a minimum to save money…then you are working in an overdemanding/ rushed environment and you have to constantly make priority decisions with patients…do I spend 5 more minutes talking with this pt about meds or do I leave now and see my patient on another unit who could be in immediate trouble? etc etc. It gets to where being calm, patient, and a good listener just sounds like a completely unrealistic cliche. You’d do it if you could but not if people are in the next room dying.
Once, while I was in Japan, I had problems with my throat, feeling difficult to swallow my food.
I went to a hospital and, after sitting in a waiting lobby for nearly two hours, was ushered in an exam “area” (I won’t call it a room because its walls were made by curtains) where a guy in a lab coat didn’t even greet me, or ask for my name, or for what was wrong with me. He only said “look up”, and when I did, he stuck in my nostrils a pair of Q-tip like sticks soaked with a substance that made my nose run. After a while he pulled out the tampons and, again without any warning, stuck a flexible endoscope in my nose which went all the way inside my throat. After looking in it for a while, he whipped the thing out of my nose and said: “You’re too fat”, before disappearing.
After that I strongly believe that a cranky doctor which will still treat you like a human being is way better than one who considers you nothing but a machine needing to be fixed.
I have worked as a health educator for over twenty years, and I have sympathy for both groups, doctors and patients. There are many issues. Medical practice is much more complex than it was. Insurance companies and administrators without medical expertise tell doctors what they can or cannot do (in the USA, but Australia will follow the same path). The whole medical system averages out patients, and those with unusual problems are side-lined as a result. Doctors are not given enough time these days to do a good job, and they are under incredible stress as a result. Doctors are trained and we need their expertise. But lay-people can also research the same books and information. People don’t want to be treated like a laboratory rat. They want to be listened to and treated with respect. It is their body, and they have patient rights. Patients need to present the main points of their case concisely and allow doctors to do their job as they have been trained. There needs to be time for patient interaction and education. These days, the latter are luxuries. It’s hard to see a resolution to all this. These are only some of the issues.
after years of advanced education and studies, dealing with the less educated general public, it is like I figure when a human lawer or doctor, tries to explain something to me, they can explain it to me, but can not comprehend it for me, so uless the back up to high school vocabulary and dumb things down for me, I am to darn embarssed to let them know I have probably basic annoying questions, but I never went to med school to learn how to save and enhance lives. dag gum it.
RUSH RUSH RUSH…as a pt I have sat in the front lobby for 45 minutes. Then called to another room where I wait for up to another 30 minutes. All that waiting for my doc to RUSH in ask me what’s wrong and rush out before I know what’s happening.
Thing of it is…this is playout out all across america in every area of seeing a “doctor”.
my wife has suffered from digestive problems and anemia for the last 10 years, were sent from doctor to doctor, test after test and all I have to show for it is an empty bank account; a doctor will say he knows the problem but when his diagnosis proves wrong then he is done, collects his fee and sends you elswhere to start over again, I am sure there are some good doctors out there but the healthcare system in our country just plains sucks. were giving up….
I’m working in a teaching hospital to get my CNA.. so of course I have met my fair share of Dr’s who are great.. and those who are not. I’m just saying- connecting with a patient is of the utmost importance. I brush their teeth- Dr’s tell them what they’re going to do about their broken arms. I find it easy to connect with patients, but I hate to hear them say “Dr. So and So doesn’t even tell me what’s going on” so I have to send in an RN to clarify because I can’t tell them even if I do know. It all comes down to the golden rule.. treat others the way you’d like to be treated.