Does your doctor think you're a 'difficult' patient?

You see yourself as an engaged and well-informed patient. You might be surprised to learn that your doctor thinks you're difficult. The difference might play havoc with your health.

This is one of those water cooler subjects for which there are no strict definitions. In general, doctors may be tempted to label patients "difficult" if they make frequent appointments for symptoms that are vague or repetitive.

Some doctors label patients difficult if they appear uninterested in the doctor's diagnostic opinion. Others label patients as difficult if they act rude, demanding, aggressive, violent, and if they have a hidden agenda to seek some sort of gain such as a prescription for an opioid.

A recent edition of EM Cases, a very popular podcast for emergency physicians, referred to difficult patients as demanding, know-it-alls, incessant complainers and patients who seem overly anxious.

Surveys have shown that doctors find roughly 15 to 20 per cent of their patients difficult. In my opinion, doctors overestimate the number of patients they find difficult based on their experience with one or two such patients.

The surveys also point to a strong association between having a mental health disorder such as anxiety or depression and being labelled as difficult by health professionals. 

To me, that says volumes more about physicians than it does about their patients.

That's the doctor's point of view. It I were to ask patients, my sense is that many of them would say that they are worried sick that they or a family member has a serious illness such as cancer or heart disease.

In that context, patients look up their symptoms and diagnoses on the internet because they want to anticipate the tests and treatments that are likely to be recommended.

In the event of a serious diagnosis, they want to know about promising new research.

Some may furnish a long list of unrelated symptoms or ask a lot of questions because they're terrified of leaving some question unasked or omitting some piece of information that turns out to be pivotal to the diagnosis.

Patient-doctor relationship

Patients with chronic illnesses (and their parents) have a unique stake in this issue. As frequent visitors to the health-care system, they have special experience on its inner workings.

One can argue that such experience gives them expertise that should be respected by health professionals. They would argue that some doctors don't want patients to be equal partners; they want prime jurisdiction on medical knowledge. 

There are patients who fear being labelled as difficult enough that they bend over backwards not to annoy the doctors. That includes biting their tongue even when they disagree with them.

The problem with being labelled a difficult patient is that it can affect the care patients receive. At some point, doctors stop listening to their words and instead tune into how they feel whenever the patient makes an appointment.

Patients so-labelled tend to be tuned out by their doctors. They aren't screened as diligently for illnesses like cancer. Their symptoms are more likely to be ignored.

I can remember one or two times in my career when I missed a serious diagnosis because I was overwhelmed by the anxiety the patient was expressing. Most experienced physicians have lost one or two patients over the years when they ignored the pleas of an anxious patient who turned out to have a very good reason to be frightened. 

So what can doctors and patients do to lessen the difficulty?

EM Cases recommends that doctors prepare to be their best selves by breathing, speaking slowly and quietly, and by acknowledging and letting go of unpleasant thoughts and feelings that get in the way of listening. They also recommend that doctors acknowledge the patient's feelings and empathize with them. 

In a recent blog post, Carolyn Thomas said she goes out of her way to keep from being labelled as difficult. She says she arrives early for appointments, nods and smiles, takes the doctor's prescription without arguing and leaves the examining room quickly so the next patient doesn't have to wait.

I hope that patients don't feel the need to do that! I'd like to believe that patients and doctors are getting closer to a level playing field. It took me a long time to get past thoughts and feelings that got in the way of meeting the patient on a level playing field. Nowadays, I'm grateful for patients who are engaged in their own health care.

I don't describe patients as "difficult." It's a label my colleagues need to give up.