6a010535fa02f4970b0133f4d5b46c970bPrimary-care physicians consider about 15-20% of their patients to be “difficult.” These patients can be demanding and rude, and they are more likely to question the doctor’s expertise on things like vaccinating children. As a result, the doctor has a harder time understanding the patient’s problem, and difficult patients are more likely to be misdiagnosed than normal patients. This may be because the doctor remembers more about the patient’s difficult characteristics than their symptoms. Surprisingly, “difficult” patients often report liking their physician quite a bit, possibly because the physician spends more time and energy with them. Furthermore, younger and less experienced physicians are more likely to describe a larger percentage of their patients as “difficult”.

Dr. Jeffrey Jackson, an accomplished medical school professor and physician, said “It’s not just patient characteristics that are involved in a patient being called difficult, but also provider characteristics.” Doctors might want to blame their patient for preventing them from making an accurate diagnosis, but this is not the right approach. Doctors should find methods that help them deal with patients that they find “difficult.” For example, Dr. Jennifer Edgoose and her colleagues developed a mnemonic to help doctors work with difficult patients: BREATHE OUT. In the first two steps of this process, the doctor reflects on the biases he or she has about the patient and on why he or she identifies the patient as “difficult.” This process places the responsibility on the doctor and recognizes that their perception of the patient could be part of the problem. The patient’s behavior is a reflection of the doctor. Younger, inexperienced doctors become experts through more experience and learning, and thus label fewer of their patients as “difficult.” Doctors should focus on what they can change about their own behavior towards “difficult” patients, and above all, they should accept their patients for who they are.





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