In light of performance measurement pressures, many doctors are likely to ensure that quality measures are met—even when faced with a challenging patient encounter.
Study limitations. This study is limited by its sample size, which may have restricted our ability to discern small but meaningful differences in quality and errors. In addition, enrollment bias—given that a small number of patients per physician were enrolled—could have muted potential positive findings. If possible, future studies should include outcomes from entire patient panels.
While the objective recording of quality and errors is a strength of this study, data on the frequency of difficult encounters were cross-sectional. As a result, causal relationships between physician-experienced difficulty and patient outcomes were not possible to determine.
Lastly, throughout this study the term “patient outcomes” has been limited to the particular medical outcomes used in our investigation. But it is well recognized that important patient outcomes could also include measures such as satisfaction, trust, medication adherence, and costs.
More to explore. We found that the perception of frequent difficult patient encounters was not associated with poorer patient outcomes, even in the setting of physician dissatisfaction and burnout. Although difficult encounters were associated with physician burnout and job dissatisfaction, it appears that physicians who perceived very frequent difficult patient encounters had comparable standards of care relative to their peers who reported fewer difficult encounters.
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Other potential consequences of difficult encounters need to be explored, such as patient satisfaction and trust.
Future research should examine additional patient outcomes related to chronic conditions and acute care and their relationship to difficult encounters. Furthermore, other potential consequences of difficult encounters need to be explored, especially those that may result from poor physician-patient communication such as medication adherence, patient satisfaction, and trust.
CORRESPONDENCE Perry G. An, MD, Newton-Wellesley Hospital, 2014 Washington Street, 2nd Floor, Newton, MA 02462; perryan@post.harvard.edu
