My difficult' patient made my heart sink. But what happens when doctors are part of the problem? | Ranjana Srivastava

"The authors interrogated studies from different countries and different non-psychiatric settings including primary care, emergency, inpatient and specialty clinics. Twenty-eight of the 45 studies used a reliable instrument called the Difficult Doctor-Patient Relationship Questionnaire, a self-administered tool completed by the doctor to identify patients whose care was experienced as difficult."

"The authors found strong evidence that physicians rate one in six patients as difficult. Mostly, these patients have personality disorders, depression, anxiety and chronic pain. Patients considered difficult reported more symptom burden and worse function."

"My surface feeling was impatience, but inside, I felt terrible that any patient should arouse such antipathy in a member of the caring profession. When she was finally discharged in good health, we were both relieved for different reasons."

Physicians commonly experience challenging relationships with patients, with approximately one in six patients rated as difficult based on standardized assessment tools. Difficult patients typically present with personality disorders, depression, anxiety, and chronic pain conditions, alongside higher symptom burden and worse functional outcomes. The Difficult Doctor-Patient Relationship Questionnaire measures physician frustration through questions about time consumption, communication barriers, manipulative behavior, and visit anticipation. These challenging relationships create emotional strain for healthcare providers, who may experience anxiety and impatience despite professional obligations to provide compassionate care. Gender disparities exist, with women more likely perceived as difficult patients. Understanding the characteristics of difficult patient relationships reveals underlying mental health and chronic illness factors rather than purely behavioral issues.

Read at www.theguardian.com