Cranky Doctor or Annoying Patient? Sometimes It's Both


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By Anne Harding
MONDAY, Feb. 23, 2009 ( — Erin Krebs, MD, once had a patient who spent the first eight minutes of his appointment telling her everything that was wrong with the past four primary care doctors he’d seen—including one she knew personally and considers a “lovely person.” “We know that doctors are not perfect,” said Dr. Krebs, an assistant professor at the Indiana University School of Medicine. “But it’s not a good start to spend a lot of time complaining about the past.”

Getting off to a bad start is not at all unusual in the doctor’s office; physicians say they have a “difficult” encounter with one in every six patients.

Now a new survey suggests that the number-one trait that most annoys doctors is a patient who insists on a prescription for a medication he or she doesn't need. But the survey, published Monday in the Archives of Internal Medicine, also shows that some docs—particularly those who are stressed or burned out—find patients more irritating than others do.

Perry An, MD, of Newton-Wellesley Hospital in Newton, Mass., and colleagues found that these doctors were less satisfied with their work, more pressed for time, and admittedly more likely to make mistakes.

“It’s not just that there are difficult patients or there are difficult doctors. Maybe there are fits that aren’t so great between the two,” said Dr. Krebs, who coauthored a 2006 study on the characteristics of physicians who report being frustrated with patients called “The Difficult Doctor.”

In the current study, the researchers surveyed 422 primary-care doctors practicing across the United States about how often they experienced eight different types of difficult encounters, from having a patient with unrealistic expectations for care to one who was disrespectful or verbally abusive. Doctors fell into three clusters based on how often they reported such difficulties, with 27% having a high number of difficult encounters, 63% a medium number, and 10% a low number.

The most common challenge doctors reported was “patients who insist on being prescribed an unnecessary drug,” with 36.7% saying they encountered such patients frequently. Additionally, 16.1% said they frequently saw patients dissatisfied with their care, and 13.7% said they frequently saw patients who had unrealistic expectations of their care.

Doctors who said they had more troublesome patients tended to be younger, on average, than the other physicians, and they were also more likely to be female.

These “difficult” doctors were 12 times as likely as the low-difficulty doctors to say they were burned out, nearly four times as likely to report high stress, and more than nine times as likely to say they had provided “suboptimal care” in the past year.

Next page: 6 ways to avoid the 'difficult' label

Studies have shown that “difficult” patients tend to have nebulous, hard-to-pin-down symptoms like headache, dizziness, and fatigue, notes Kurt Kroenke, MD, of the Regenstreif Institute in Indianapolis, who wrote an editorial accompanying Dr. An’s study. Certain doctors just don’t like dealing with these types of patients, he added; in his editorial, Dr. Kroenke notes that “physicians with a distaste for the psychosocial side of patient care” identify 23% of their encounters with patients as difficult, compared to 8% of their “more psychosocially oriented colleagues.”

So how can you avoid being labeled a difficult patient, possibly by a doctor who’s just impatient and stressed out? Experts on the patient-physician relationship agree there are things you can do, including coming to your doctor’s office prepared and being aware of time constraints.

“The advice goes for both patient and doctor, including myself, to state up front what are our goals for the time we’re spending together, also our expectations, and also to have an understanding of the time limitations we have going forward,” Dr. An said. If time runs out before you can address all of your issues, he adds, you can make another appointment.

Experts on physician-patient relationships recommend that you:

Make a list. Decide what is the most important thing to discuss with your doctor, advises Dr. Krebs. If your list is long, pick two or three top priorities.

Bring your medicine with you. Make a complete list of what you’re taking, including nonprescription drugs, supplements, and herbal medicines. One of Dr. Krebs' pet peeves, she admits, is a patient who, when asked what medicines she’s taking, says, “Well, that’s your job to know.”

Bring up your top concerns early. “It’s better to bring it up earlier than right at the end of the encounter, as the doctor is getting up to leave the room, because that’s frustrating for both patient and doctor,” says Dr. Kroenke. “Put it on the table as the appetizer, not the dessert.”

Tell your doctor the truth. For example, if you haven’t been taking your blood pressure medication regularly, don’t say you have; this could lead to a prescription for another drug that you wouldn’t need if you were taking the other one as recommended.

Ask your doctor about—but don’t demand—a certain drug. You should “take Internet research and advertising with a grain of salt,” adds Dr. Krebs. “Understand that you might not have the whole story and be open to the possibility that a particular treatment or medication might not be the right one for you.”

Think about switching doctors. There are certain situations where patient and doctor just aren’t a good match, according to Dr. Krebs. “We’re all human beings, and we all have our personal strengths and weaknesses, our pet peeves that we bring with us.”

If you feel like your doctor is difficult to understand or won’t answer your questions, you should feel comfortable telling him this and asking him to clarify. “This may be a fine doctor, but perhaps again the visits are just too short and the doctor is just trying to be efficient and get to the next patient on time,” Dr. Krebs said. If you get a sense that your doctor is being impatient with you, “you can always ask about it: 'How could I explain myself better? What information do you need?’ Those kinds of clarifying questions might help,” she says.

In the case of her complaining patient, Dr. Krebs says she was able to turn things around by telling him that it must have been tough to see a string of doctors he didn't like, but that the two of them should have a fresh start. She then asked him to summarize two or three of his most important concerns. “That seemed to change the subject and help a little bit.”