The difficult inpatient, prevalence and characteristics.

BACKGROUND

Up to 18 % of ambulatory clinic patients are considered difficult by their primary care providers. Two qualitative studies suggest that inpatient medicine providers also commonly experience hospitalized patients as difficult. There have been no quantitative studies of how often hospitalized patients on medicine services are perceived as difficult. Our study purpose was to assess the prevalence and characteristics of difficulty.

METHODS

Hospitalized patients were randomly selected and their inpatient providers (hospitalist, non-hospitalist medicine faculty, medicine resident and interns) completed surveys on experiencing patients as difficult. Difficulty was rated on a dichotomous (yes/no) and continuous (0-10) scale. Characteristics extracted from the chart included patient demographics, cognitive status, Charlson comorbidity index, length of stay, and whether the patient had a chart diagnosis of depression, anxiety, PTSD, chronic pain, somatization disorders or personality disorders.

RESULTS

There were 322 surveys completed on 202 unique inpatients; 24.5 % were considered difficult. Age, mental health comorbidities (depression, anxiety), and medical complexity were not associated with being perceived as difficult. On multivariate analysis, personality disorders (OR: 5.4, 95 % CI: 2.6-10.9) and chronic pain (OR: 2.1, 95 % CI: 1.2-3.8) were the only characteristics independently associated with increased difficulty ratings.

LIMITATIONS: Single site, VA patients, potential response bias.

CONCLUSION

Medicine inpatients are commonly experienced as difficult by their providers. Chronic pain and personality disorders increased the likelihood of being experienced as difficult.