Almost 18% of patients are considered difficult by physicians, according to a new study — which also found that this group is more likely to experience worse short-term outcomes than other patients.

Unlike previous studies assessing difficult patient encounters, in this one the investigators also analyzed physician factors contributing to the difficult encounters. They found that older, more experienced physicians don’t appear to be as disturbed by difficult patients.

Among the 750 adults with a physical symptom observed at primary care walk-in clinics, 17.8% were perceived by doctors as being difficult. Difficult patients were defined as  those who were less likely to fully trust or be satisfied with their physician and also were more likely to have worsening of symptoms at 2 weeks. Patients identified as “difficult” included those with more than 5 symptoms who also had a depressive or anxiety disorder. Typically, the lead author notes, they are not patients with complex medical conditions, but more often patients with unexplained physical symptoms, stress, pain, and discomfort.

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Physicians involved in these difficult encounters, however, were less experienced and had worse psychosocial orientation scores. Those with fewer than 10 years’ experience reported that almost 1 in 4 patients were difficult, while those with 20+ years experienced ranked just 2% of patients as such.

The findings were published online January 26 by the Journal of General Internal Medicine.