Researchers Explore Nature of Difficult Clinical Encounters

Patients, physicians both contribute characteristics; difficult patients have worse outcomes

MONDAY, Feb. 14 (HealthDay News) -- Both patients and physicians can bring qualities to a clinical encounter that result in its being perceived as difficult, and patients involved in these types of encounters have worse short-term outcomes, according to research published online Jan. 25 in the Journal of General Internal Medicine.

Sherri A. Hinchey, M.D., M.P.H., of the Tripler Army Medical Center in Honolulu, and Jeffrey L. Jackson, M.D., M.P.H., of the Zablocki VA Medical Center in Milwaukee, surveyed 750 adults presenting at a primary care walk-in clinic with a physical symptom to explore both patient and physician characteristics associated with "difficult" clinical encounters and to assess the effect this has on patient outcomes.

The researchers found that 17.8 percent (133) of the patients were considered difficult. These patients were less likely to be trusting, or to be fully satisfied, and more likely to experience worsening of their presenting symptoms two weeks later. Patient characteristics associated with difficult encounters included having more than five symptoms, depression or anxiety disorders, and endorsed recent stress. Physician characteristics associated with difficult encounters included less experience and poorer psychosocial orientation scores.

"A number of approaches to managing difficult encounters have been proposed, though most have not been rigorously tested. Research directly observing patient and provider behaviors during 'difficult' encounters as well as identifying changeable physician behaviors that improve outcomes are needed," the authors conclude.

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