Nobody likes everyone they meet. Sometimes we judge others based on their behavior, and other times we judge based on the way people look, their job, or their background. What if turns out that your doctor doesn’t like you? Or your doctor is biased against you because of your weight or intelligence? Your relationships with your doctors are among the most important relationships in your life. Why? Because a strong relationship helps you get the best care and outcome possible. But good doctor-patient relationships, which takes a commitment from both sides, might be easier said than done.

Doctor-patient relationships impact the quality of care.

Your relationships with your doctors can impact your health care and outcomes. Experts agree that a doctor’s negative attitude towards a patient can adversely impact health care quality and contribute to health disparities.

Doctors know it, and you should realize it too. In fact, in a 2010 Consumer Reports survey, doctors reported that a strong doctor-patient relationship is the most important thing a patient can do to get better medical care. Furthermore, 76% of respondents stated that strong relationships help patients “very much”.

A study published in September, 2020 highlights the impact of a positive relationship between patients and doctors. The study found that “improved physician-patient relationships were associated with improved functional health, whereas worsened physician-patient relationships were associated with worsened functional health.”

Certainly, not all doctor-patient relationships are positive. Doctors are people, and just like all other people, they like some people more than they like others. Furthermore, sometimes doctors find patients difficult, or hold biased feelings towards them. And sometimes patients don’t like their doctors for any number of reasons.

Does your doctor think you are “difficult”?

It’s hard to be happy and in a good mood 100% of the time, particularly if you’re sick, scared, stressed and/or exhausted. Even so, no one wants to be labeled as difficult.

Yet, research shows that as many as 15% of patients are seen as difficult by their doctors. Could that include you? Would you even know if your doctor found you difficult?

Experts report that doctors find patients difficult when they:

Are angry and/or demanding.
Are never satisfied.
Suffer from many medical problems yet struggle to focus on health issues.
Have many physical complaints and symptoms, with a tendency to indicate severe symptoms.
Have low health literacy.
Self-diagnose based on internet research or TV medication ads.
Refuse, or insist, on particular treatments.

Interestingly, one study found that patients who were labeled as difficult actually reported a fondness for their doctors and an ease of communication with their doctor. This is likely due to doctors spending extra time and energy with the difficult patients, making them happy that they received extra attention.

The dangers of being seen as a difficult patient.

Certainly, if your doctor thinks you’re difficult, you may have unpleasant appointments. However, it can also lead to a misdiagnosis which can cause delays in care and/or inappropriate treatments.

What do studies show?

In order to determine the impact of patient behavior on diagnostic errors, researchers created six different scenarios involving difficult or neutral patients. The 6 difficult patient categories were patients who:

Were “frequent demanders”.
Behaved aggressively.
Questioned the doctor’s competence.
Ignored doctor’s advice.
Had low expectations.
Presented herself as completely helpless.

The researchers found that patients who were difficult were more likely to have a diagnostic error. For example, in complex cases, doctors made 42% more diagnostic errors with patients considered difficult (disruptive) compared to non-difficult patients. Unsurprisingly, the difference in error rates were significantly lower for simpler medical issues.

Why is it harder for doctors to accurately diagnose difficult patients?

We all know that dealing with difficult people can be emotionally and mentally fatiguing. And, doctors are not immune from these feelings. It’s only logical that the fatigue of dealing with a difficult patient can make it hard to provide an accurate diagnosis.

Researchers agree – they determined that the behaviors of difficult patients “induce doctors to make diagnostic errors, apparently because doctors spend part of their mental resources on dealing with the difficult patients’ behaviours, impeding adequate processing of clinical findings”.

Is your doctor biased against you?

What if something about you automatically made your doctor not like you? Seems unfair, right? However, doctors can be biased against patients, which not only negatively impacts the doctor-patient relationships, it can also harm patients.

And, it’s more common than you might assume. A 2017 survey by Medscape asked doctors if they thought they were biased against specific types or groups of patients. Overall, 50% of doctors admitted feelings of bias towards specific groups of patients.

What patient characteristics trigger bias?

Among respondents who admitted biased feelings, the most common patient characteristics cited as reasons for bias were:

Patients with emotional problems.
Overweight patients.
Patients who they perceived had low intelligence.
Patients with language differences.

Does bias affect treatment?

The good news is that only a small percentage of doctors (about 16%) stated that their bias affected their treatment. However, it’s easy to imagine that doctors biased against a patient might have some of the same struggles to properly diagnose patients as when doctors treat a difficult patient.

Patients who feel discriminated against may avoid medical care.

Importantly, Black and Hispanic/Latinx adults report experiencing discrimination when seeking healthcare at higher rates than white adults. And these feelings of discrimination can translate into health problems as patients avoid medical care.

An Urban Institute’s 2020 survey asked people if have felt that doctors have treated or judged them unfairly based on their race or ethnicity, and if so, how it impacted their care. Importantly, among the 3.2% of nonelderly adults who reported feelings of discrimination, 75.9% reported that such treatment or judgment disrupted their receipt of healthcare. Within this group:

39% delayed care.
34.5% looked for a new healthcare provider.
30.7% did not get needed care.

Stigmatizing language in your electronic health records can impact future care.

If a doctor uses stigmatizing language in your medical record, it can perpetuate negative attitudes and influence doctors who care for you in the future. To determine what kinds of language doctors include in records, researchers evaluated 600 appointment notes and found doctors include both negative and positive opinions about their patients in their records.

Interestingly, the negative language was not explicit, and included doctors’ comments expressing:

Questioning patient credibility.
Expressing disapproval of patient reasoning or self-care.
Stereotyping by race or social class.
Portraying the patient as difficult.

In contrast, positive language was more often more explicit and included comments expressing:

Direct compliments.
Expressions of approval.
Self-disclosure of the doctor’s own positive feelings toward the patient.

What’s in your records?

The only way to learn if your doctor has included negative language about you in your record is to look at your records yourself. This is particularly important if you suspect that your doctor has negative feelings about you. If your doctor uses electronic health records, you should be able to access your appointment notes through their portal. If your doctor uses paper notes, ask for a copy of your records.

Yes – doctors have favorite patients.

A study conducted by the Johns Hopkins Bloomberg School of Public Health interviewed 25 doctors to determine doctors’ attitudes towards their patients. They found that although doctors like most of their patients, a majority of the doctors like some patients more than others.

Doctors identified “favorite patients” as either a type of patient or specific patients. Furthermore, many doctors stated their favorite patients were people who at some point were very sick and therefore frequently seen over a period of time, ranging from one year to decades.

But, don’t despair if you suspect you are not the favorite! Doctors reported they treat all of their patients with equal attention and care.

On the other hand – how do you treat your doctor?

As with all relationships, all doctor-patient relationships are two-way streets. Even though a good relationship with your doctor is key to getting the best care, many patients treat their doctors rudely.

For example, researchers found that patients frequently make biased, rude comments about their doctor’s personal characteristics. Moreover, doctors report that these offensive comments have a large negative impact on their emotional health and on their ability to do their jobs.

For more information, read How Do You Treat Your Doctors?

Do you sense that one of your doctors doesn’t like you?

If you feel that your doctor has labeled you as difficult, or is biased against you, consider the following:

Have an honest conversation with your doctor about how to improve your relationship. It might feel awkward, but it can help.
Be pleasant and calm when you see your doctor, even if you don’t feel well. But, make sure you tell your story, ask your questions, and get answers you understand.
If you struggle to keep your emotions in check during appointments, consider bringing someone with you who will help you stay calm.
Listen carefully and evaluate what your doctor is recommending. You have a right to refuse testing, treatments and/or medications, but don’t make rash decisions and don’t be rude.
If you feel a particular doctor considers you difficult, yet you don’t get this feeling from all your other doctors, it might be time to switch doctors. For more information, read When Is It Time To Change Doctors?
Do you sense that many or most of your doctors think are you are difficult? If so, it might be time to evaluate your own behavior and attitude.
If you feel your doctor is biased against you, don’t talk yourself out of these feelings. Consider reporting your doctor’s behavior to his/her supervisor. To bolster your case (and to help you determine if your concerns are valid), keep notes detailing any offensive, biased comments or behaviors, including dates. For more information, read When and How to Report Doctor Misconduct.

One more tip for good doctor-patient relationships – use doctors you trust.

It’s hard to imagine having strong doctor-patient relationships with your doctors if you don’t trust their skills and opinions. Certainly, it would be difficult to follow recommendations made by a doctor you don’t trust. So, it’s logical that patients’ level of trust impacts the quality of care and outcomes.

Researchers reviewed data from several dozen studies to evaluate the link between patients’ trust in their providers and health outcomes. Unsurprisingly, they found a strong correlation between trust in providers and patient satisfaction with treatments. Additionally, they found a somewhat smaller correlation between trust in providers and patient improvements in beneficial health behaviors, quality of life, and symptoms.

Although a trusting relationship is important, many patients don’t always trust their doctor. For instance, a 2020 survey of over 30,000 Americans revealed that many patients don’t always trust their healthcare provider to make the right decisions for them. Here is the breakdown by age group:

Learn more…

Since being an engaged member of your medical team can help you get the best care and outcome possible, read these blog posts for more information:

NOTE: I updated this post on 10-13-21.

Why are Doctor-Patient Relationships Vital?

Doctor-patient relationships impact the quality of care.

Does your doctor think you are “difficult”?