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People are often quick to criticize a doctor's bedside manner. But how many stop to consider what their doctor thinks about having to put up with them?

A new study of Canadian physicians reveals that many often have to deal with troublesome patients who may act aggressively or refuse to believe the doctor's diagnosis, among a range of other problems.

While such snags may seem like minor annoyances, they could have significant implications for patient safety, according to the study conducted by researchers at the University of Manitoba.

"When you have patients that can't communicate, there's going to be a big issue. ... physicians may not be able to provide the right diagnosis," said Raymond Lee, professor of business administration and one of the study's authors.

And when patients won't heed the physician's advice, "it can affect their actual health outcome if they don't follow through with treatment plans."

In the study, presented in June at a conference on health-care systems and patient safety in Strasbourg, France, researchers asked nearly 300 Manitoba doctors about the daily obstacles they face when dealing with patients. They found that many physicians feel they have insufficient time with patients and that they have difficulty establishing a good rapport.

In addition, some doctors said many patients are quick to self-diagnose using the Internet, and are often resistant to the physician's diagnosis and course of treatment.

"In the modern economy we have the Internet and peer pressure, so there are all kinds of influences," said Brenda Lovell, an instructor of community health science at the University of Manitoba and one of the study's authors. "There's a safety implication."

In addition, many physicians reported they face challenges from patients who don't disclose that they use "natural" or alternative therapies.

Pediatricians were most likely to make this complaint. Although it didn't examine why young patients may be more likely to use natural remedies without telling their doctor, the research raises questions about how frequently this may be occurring and how it could affect a young person's care.

One of the problems is that many people don't realize that natural remedies and herbal treatments can interfere with other medications and lead to potentially dangerous interactions, Ms. Lovell said.

"I think it's important that, for patients, they be educated on the fact there are interactions, especially with drugs," she said.

Communication problems were especially pronounced among physicians dealing with patients of the opposite sex.

Female physicians reported greater difficulty establishing rapport and having sufficient time with male patients. But those difficulties declined substantially when female doctors saw female patients, the survey found.

There is a growing awareness of the need to improve communication between doctors and their patients. said Janet McElhaney, geriatrician and professor of medicine at the University of British Columbia.

"I think that we run into problems when ... people are presented with information that is overwhelming and not understanding the jargon that we sometimes use," she said.

Dr. McElhaney is a member of the British Columbia Medical Association, whose Council on Health Promotion recently passed a motion to help educate patients so they can better understand the information doctors give them.

"I would say we need to do better with what's available with the current technology around giving patients information in ways that are digestible," Dr. McElhaney said.