Nearly one in six outpatient medical appointments—around 17%—are considered “difficult” by healthcare providers, according to a new meta-analysis published in Annals of Internal Medicine. This finding highlights a significant challenge in healthcare delivery, potentially impacting both patient care and provider well-being.
Researchers, led by Jeffrey L. Jackson, MD, MPH, and colleagues from the United States and Japan, analyzed data from numerous studies to determine the prevalence and characteristics of these challenging patient encounters. The team reviewed scientific literature from databases including MEDLINE, EMBASE, Web of Science, PsycINFO, and the Cochrane registry, up to July 7, 2025.
The combined analysis revealed that approximately 17% of ambulatory appointments are perceived as difficult by physicians and other healthcare professionals, with a 95% confidence interval of 0.15–0.19. This suggests that relational or organizational complexities are present in a substantial portion of clinical interactions.
The study identified several patient characteristics associated with a higher likelihood of being perceived as difficult. Personality disorders were the strongest factor, with a relative risk of 2.2 (95% CI: 1.5–3.1). Anxiety disorders (RR 2.1; 95% CI: 1.7–2.6) and depression (RR 1.9; 95% CI: 1.7–2.2) were also strongly correlated with these challenging encounters.
Chronic pain also emerged as a significant factor, with a relative risk of 1.9 (95% CI: 1.5–2.4). Patients experiencing chronic pain often present with a higher number of symptoms and more complex care expectations.
Interestingly, a provider’s level of experience also played a role. Healthcare professionals with fewer years of practice were more likely to characterize an appointment as difficult. On average, those facing these situations had 3.5 fewer years of experience compared to their colleagues (weighted signify difference: –3.5 years; 95% CI: –5.0 to –1.9). Researchers suggest that increased clinical experience may improve a provider’s ability to manage complex interactions and adjust patient expectations.
Appointments considered “difficult” were also linked to less favorable patient outcomes. Patients in these encounters were nearly twice as likely to report that their expectations were not met (RR 1.9; 95% CI: 1.4–2.5), and reported lower overall satisfaction (RR 0.76; 95% CI: 0.65–0.88). These results suggest that difficult consultations often reflect a disconnect between a patient’s needs and the healthcare system’s ability to address them.
The researchers acknowledge some limitations, including variability in how “difficult consultation” was defined across studies and a lack of data for certain secondary analyses. Despite these limitations, the meta-analysis confirms that challenging patient encounters are a frequent reality in clinical practice, particularly in patients with mental health conditions or chronic pain.
The study’s authors believe these findings could help refine strategies for training and organizing care, ultimately improving the quality of doctor-patient interactions and increasing satisfaction for both parties.
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