It’s simply human nature, but some patients don’t like their doctor and doctors certainly don’t like all of their patients. I’m as guilty as anyone of judging people even though I tried very hard not to let a patient know how I felt about their situation. Personality differences are a big issue, and both physicians and patients present a wide variety of characteristics that don’t always mesh. “Difficult patients” are an every day occurrence, and before we venture further, defining “difficult” is a place to start.
“Difficult” in this context, does not mean the patient who is a diagnostic challenge. On the contrary; diagnostic challenges are the exciting part of the practice of medicine. They’re the things that get our “juices” going and are part of why we became doctors. It’s solving the unknown and putting together all the facts and data needed to make the final diagnosis. NO, that’s the fun part of medicine.
“Difficult” patients are the folks with whom you clash because they have a persona that affects the way you react to them. They generate within the physician impatience, confusion, and even anger. An explanation of my opinion of the various difficult patient situations will follow next.
I’ll start with what the medical profession calls “the poor historian.” These folks have a very difficult time putting their symptoms into words or following a logical sequence in the progression of their problem. Pinpointing the location of pain and describing what it’s like is very hard for them to do. Answering specific questions leads to answers that don’t help to get at what’s going on. They talk slowly, disjointedly, and never make their point. These patients generate impatience and frustration in the doctor that make them “difficult patients.”
The depressed patient falls into the “difficult” category, too. These patients rarely come in to their appointment and say, “I’m depressed and I need something to make me feel better.” No. It’s not that easy. They present with symptoms—fatigue, insomnia, abdominal pain, GI symptoms, headaches— which could be from just about any cause. These patients can be evasive, sad, anxious, emotionally up or down. I often found that I could more easily diagnose depression because the affect of the patient was so flat they made me depressed.
Patients with chronic pain or those dealing with a chronic progressive disease are difficult for two reasons. One, it seems the pain is impossible to control and repeated failure of therapeutic options becomes very discouraging. Two, it’s upsetting to see a patient with a debilitating disease, like MS or ALS, deteriorate slowly and not be able to do anything to help. Each time the patient has an appointment, coming up with something to relieve the pain or slow progression is very difficult.
Then, there is the non-adherent, non-compliant patient who skips appointments, won’t take the prescribed medication, or just ignores what you say. They are “difficult” because you know if they were adherent to the treatment plan, they would be better and the doctor would feel a sense of accomplishment. But they don’t, and the doctor dreads seeing them.
Getting patients to stay on point and not ramble, talk tangentially, or be distracted can be very difficult. When couples share appointments (are seen together at the same time) the time frequently would get out of hand and the appointment would last much longer than the allotted time. They fed off one another and would say to each other,”tell him about this or that.” “This or that” would extend the time into the next person’s appointment time. That was very hard to control and couples appointments were usually quite long, marathon sessions!
In Family Medicine I was fortunate not to have to encounter patients who were drunk, under the influence of drugs, belligerent, threatening, or rude. This behavior is standard for the Emergency Medicine physician who see all comers, and must bite his lip to control his feelings. Situations of that type almost never occurred in my office.
There are many other patient types and scenarios that are difficult patients. These are just a few to give you an idea what I mean. People with personality disorders, severe depression, drug seekers, and non-compliant people with bizarre symptoms were difficult, true, but they were offset by the many people who were good communicators and expressed appreciation for the time I spent with them. They are the patients it was easy to like and made the hours in the office truly enjoyable.
The “difficult” patients were just a small segment of the patients seen every day, but they took more time, energy, and patience. Fortunately for me, most of these people were just as appreciative of my efforts as the others. It was just more difficult for them to express it.
Reference: Wajngarten M. One in Six Patients Labeled “Difficult”: What’s Behind It? Medscape 2026 March 3.
