The Prevalence and Characteristics of Difficult Patient Encounters. A Systematic Review and Meta-analysis and "Difficult Patients," Persistent Symptoms, and the Biopsychosocial Model

(from March 2026 Annals for Educators)

Some physician–patient interactions are perceived as difficult. This systematic review searched 10 databases and included 43 articles of 45 studies to estimate the prevalence of difficult patient encounters among adults being seen in nonpsychiatric settings. The authors also assessed patient and provider characteristics associated with difficulty as well as patient outcomes. The accompanying editorial discusses the findings in light of the challenges of being and caring for patients with persistent physical symptoms.

Use this article and the editorial to:

• What has been your experience with “difficult” patients and how do they compare with the characteristics of “difficult” patients reported in this review?
• What is the quality and heterogeneity of the available evidence included in this review? How does this influence your confidence in the quantitative findings the authors present?
• Consult a behavioral health specialist to help coach you during role-play of conversations with “difficult” patients. Such patients might include those with chronic pain or anxiety who are dissatisfied with the interventions being offered or those who are requesting imaging studies that are not indicated.

Annals for Educators is a Web Exclusives feature of Annals of Internal Medicine which includes activities using selected Annals articles to help medical educators in their teaching activities.

Back to the April 2026 issue of ACP IMpact