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By Rita Rubin, USA TODAY
Remember the Seinfeld episode where word got
around that Elaine was a difficult patient? That scenario might not be so
far-fetched. For 30 years, studies consistently have found that doctors
call one out of every five or six patient encounters "difficult."
The latest, in today's Archives of Internal Medicine, found that primary-care doctors who felt they had a high number of "difficult" patient encounters were younger and more likely to be women.
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Researchers surveyed 449 general internists and family practitioners at 118 U.S. clinics, asking them to estimate how often they encountered patients with any of eight attributes ascribed to the most difficult. A patient insisting on an unnecessary drug was the most frequently cited challenge, cited by more than a third of respondents. About one in six respondents said they frequently saw patients who appeared to be dissatisfied with their care. One in seven said patients frequently had unrealistic expectations. "Difficult" patients also ignore medical advice, complain persistently, insist on unnecessary tests and do not express appropriate respect. Women made up half of doctors who reported the most difficult encounters, but only 27% of those who cited the fewest. Doctors reporting more difficult patients were also more likely to report burnout. It's not clear whether such encounters contributed to burnout or burnout made doctors less tolerant, says lead author Perry An, a general internist at Newton-Wellesley Hospital in Newton, Mass. The average age of doctors reporting the most difficulties was 41, vs. 46 for those reporting the least. Perhaps, An speculates, doctors cope better as they become more experienced. Why might women be more likely to have difficult patient encounters? Erin Krebs, a researcher at the Indianapolis Veterans Administration Medical Center, says women might attract patients who demand lots of attention. "Patients who have more psychosocial concerns may perceive a woman doctor as being more understanding," says Krebs, who wasn't part of An's study. Krebs and An agree that the doctor-patient relationship goes both ways. Patients can help by coming prepared, they say. "Understand upfront what the time constraints are," An says. And, says Krebs, raise the most pressing issues first so that you don't run out of time. READERS: Have you ever been a difficult patient? Why or why not? What are your tips for a productive, pleasant-as-possible doctor's visit?
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Researchers have consistently identified
these as behaviors of "difficult" patients: 
