Identified as “the patient whose care experienced to be most difficult that day” Population of “distressed high utilizers”, physicians’ frustration was associated with somatization and disproportionately high utilization. “nominated” by their physician for psychiatric studiedĪ group of HMO high utilizers who had anxiety,ĭepression or somatization, or who had been Largely anecdotal, a few recent studies have While the studies described above have been The phenomena of somatizationĪnd hypochondriasis are also well known forĬreating frustration and negative feelings in Lipsitt emphasizes personality disorder in his discussion of On models of personality typology, as is KahanaĪnd Bibring’s description of the impact of personality types on medical care. Personality types and disorders have longīeen thought to play a part in difficulties in theĭescription of the “hateful patient” is based The health care system by patients with psychiatric disorders take place in medical rather than Population, and the majority of contacts with In view of the substantial evidence that psychopathology is common in the general medical Suggested as an important characteristic ofĭifficult patients. Psychopathology [ 13-161, especially undetected psychopathology Patientĭifficult relationships have also been studied Have received some theoretical and in at least Methods for identifying difficult patients.įeatures of the doctor-patient relationship inĪmong those dimensions that have been examined, communication patterns have received extensive attention. Morale and utilization also depends on adequate Outcome of care, patient satisfaction, provider The difficult doctor-patient relationship on the Identifying the difficult doctor-patient relationship has left basic questions of the prevalence ofĭifficult relationships and their characteristics Has long been suspected that difficulties in the Which the physician delivers all medical care. Relationship may also arise because of the uniqueįocusing on the difficult doctorpatient relationship There may be “difficult patients” who are May be modified by the setting in which care is The need to identify and understand these components of difficult patientīehavior and to include the doctor-patient relationship in strategies for managing the Patients were characterized by psychosomatic symptoms, at least mild personalityĭisorder, and Axis I (major) psychopathology, and most had mo re than one of theseĬharacteristics. Most medical diagnoses were not associated with DDPRQ score. Demographic characteristics, provider characteristics and The DDPRQ classified 10.3-20.6% of patient encounters as “difficult”ĭepending on the sample. Factor analysis revealed 5 dimensions with face Participated in the instrument development (n = 92), reliability (n = 224), and assessment of patient characteristics phases (n = 113) of the study. Adult patients and their providers in an academic, municipal hospital clinic (DDPRQ), composed of 30 Likert items, completed by physicians after encounters with
We developed the Difficult Doctor-Patient Relationship Questionnaire Reliable methods for identification ofĭifficult patients have not been available for the empirical study of their prevalence andĬharacteristics. The subject of considerable anecdotal study. (Received in reoised form 10 December 1993) Psychology Program, Albert Einstein College of Medicine, New York, U.S.A. Medicine, New York, ‘Ferkauf Graduate School of Psychology, Bronx, NY 10461 and “Health PA 15213, 4Department of Epidemiology and Social Medicine, Albert Einstein College of
New York, ‘Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, ‘Department of Medicine and ‘Department of Psychiatry, Albert Einstein College of Medicine,
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