title: Does a higher frequency of difficult patient encounters lead to lower quality care?
abstract: BACKGROUND
  Difficult patient encounters in the primary care office are frequent and are associated with physician burnout. However, their relationship to patient care outcomes is not known.
  
  
  OBJECTIVE
  To determine the effect of difficult encounters on patient health outcomes and the role of physician dissatisfaction and burnout as mediators of this effect.
  
  
  METHODS
  A total of 422 physicians were sorted into 3 clusters based on perceived frequency of difficult patient encounters in their practices. Patient charts were audited to assess the quality of hypertension and diabetes management and preventive care based on national guidelines. Summary measures of quality and errors were compared among the 3 physician clusters.
  
  
  RESULTS
  Of the 1384 patients, 359 were cared for by high-cluster physicians (those who had a high frequency of difficult encounters), 871 by medium-cluster physicians, and 154 by low-cluster physicians. Dissatisfaction and burnout were higher among physicians reporting higher frequencies of difficult encounters. However, quality of patient care and management errors were similar across all 3 groups.
  
  
  CONCLUSIONS
  Physician perception of frequent difficult encounters was not associated with worse patient care quality or more medical errors. Future studies should investigate whether other patient outcomes, including acute care and patient satisfaction, are affected by difficult encounters.
authors: Newton-Wellesley Hospital, Newton, MA 02462, USA. perryan@post.harvard.edu
authors: Perry G
authors: PG
authors: An
authors: Linda Baier
authors: LB
authors: Manwell
authors: Eric S
authors: ES
authors: Williams
authors: Neda
authors: N
authors: Laiteerapong
authors: Roger L
authors: RL
authors: Brown
authors: Joseph S
authors: JS
authors: Rabatin
authors: Mark D
authors: MD
authors: Schwartz
authors: P J
authors: PJ
authors: Lally
authors: Mark
authors: M
authors: Linzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002055:Burnout, Professional / Q000453:epidemiology*; D054869:Clinical Audit; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D007388:Internal Medicine; D007588:Job Satisfaction; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D015146:Midwestern United States; D009519:New York City; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011322:Primary Prevention / Q000706:statistics & numerical data; D011787:Quality of Health Care