‘Difficult’ patients nag healthcare providers

Healthcare providers at times perceive clinic patients as “difficult” to handle, according to a study. These patients tend to have depression, anxiety, chronic pain, personality disorders, and more symptoms.

A team of investigators performed a systematic review and meta-analysis using the databases of Medline, Web of Science, SciELO, ProQuest, Theses, Scopus, PsychInfo, Cochrane Central Register of Controlled Trials, Global Index Medicus, and Embase (inception through 7 July 2025).

After identifying eligible studies, the investigators extracted data on prevalence, patient characteristics (sex, mental health diagnosis, somatization, personality disorders, and chronic pain), provider characteristics (type, sex, burnout, encounter setting, and years of experience), and encounter outcomes (patient unmet expectations and satisfaction).

Difficult encounters among clinic patients had a prevalence of 0.17 (95 percent confidence interval [CI], 0.17‒0.19). Such difficulty was associated with the following patient characteristics: personality disorders (relative risk [RR], 2.2, 95 percent CI, 1.5‒3.1), depression (RR, 1.9, 95 percent CI, 1.7‒2.2), anxiety (RR, 2.1, 95 percent CI, 1.7‒2.6), and chronic pain (RR, 1.9, 95 percent CI, 1.5‒2.4).

Notably, providers with less experience (weighted mean difference, ‒3.5 years, 95 percent CI, ‒5.0 to ‒1.9) tended to rate more patient encounters as difficult, and those perceived as such were more likely to have unmet visit expectations (RR, 1.9, 95 percent CI, 1.4‒2.5) and lower satisfaction (RR, 0.76, 95 percent CI, 0.65‒0.88).

“Less experienced providers were more likely to judge patients as difficult,” the investigators said. “Patients from difficult encounters had more unmet visit expectations and less satisfaction.”

The study was limited by inadequate data and heterogeneity for many secondary analyses.