Nearly One in Six Outpatient Visits Involves a ‘Difficult’ Patient, Study Finds

Approximately 17% of outpatient medical consultations are perceived as “difficult” by healthcare providers, according to a recent meta-analysis published in Annals of Internal Medicine. These challenging interactions are often linked to patients with underlying psychological disorders, chronic pain, or unmet expectations.

Prevalence and Characteristics of Difficult Consultations

Researchers, led by Jeffrey L. Jackson, MD, MPH, of the Medical College of Wisconsin, analyzed data from multiple studies to estimate the prevalence of difficult consultations in non-psychiatric settings. The analysis, which included data synthesized from studies available in databases like MEDLINE, EMBASE, and PsycINFO up to July 7, 2025, revealed a combined estimate of 0.17 (95% confidence interval: 0.15–0.19) for the proportion of consultations considered difficult. ¹

The study highlights significant variability across studies, likely due to differing definitions of what constitutes a “difficult” consultation.

Patient Factors Associated with Difficult Interactions

Several patient characteristics were identified as being associated with a higher likelihood of being perceived as difficult by healthcare providers:

• Personality Disorders: A relative risk of 2.2 (95% CI: 1.5–3.1) was observed.
• Anxiety Disorders: A relative risk of 2.1 (95% CI: 1.7–2.6) was found.
• Depression: A relative risk of 1.9 (95% CI: 1.7–2.2) was identified.
• Chronic Pain: A relative risk of 1.9 (95% CI: 1.5–2.4) was noted. Patients with chronic pain often present with multiple symptoms and complex treatment expectations.

Provider Experience Matters

The study also found that less experienced healthcare providers were more likely to rate a consultation as difficult. Professionals encountering these situations had, on average, 3.5 years less experience than their colleagues (weighted mean difference: –3.5 years; 95% CI: –5.0 to –1.9). ² This suggests that clinical experience may improve a provider’s ability to manage complex interactions and adjust patient expectations.

Impact on Patient Satisfaction

Consultations perceived as difficult are also linked to lower patient satisfaction. Patients in these interactions were almost twice as likely to report that their expectations were not met (RR 1.9; 95% CI: 1.4–2.5) and had a lower overall satisfaction level (RR 0.76; 95% CI: 0.65–0.88). These findings suggest a disconnect between patient expectations and the healthcare system’s ability to address them.

Study Limitations and Future Directions

The researchers acknowledge limitations, including the heterogeneity of the studies analyzed and gaps in data for certain secondary analyses. Despite these limitations, the meta-analysis underscores the frequent occurrence of difficult consultations, particularly in patients with psychological comorbidities or chronic pain.

The authors suggest that these results could inform strategies for improving training and care organization to enhance doctor-patient interactions and overall satisfaction. Jeffrey L. Jackson, MD, has also published related research on physician evaluations and patient communication. ³