The difficult doctor-patient relationship: Somatization, personality and psychopathology

doi:10.1016/0895-4356(94)90212-7

Journal of Clinical Epidemiology

Volume 47, Issue 6, June 1994, Pages 647-657

https://doi.org/10.1016/0895-4356(94)90212-7 Get rights and content

Abstract

The difficult doctor-patient relationship and “difficult patients” have been the subject of considerable anecdotal study. Reliable methods for identification of difficult patients have not been available for the empirical study of their prevalence and characteristics. We developed the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ), composed of 30 Likert items, completed by physicians after encounters with patients. Adult patients and their providers in an academic, municipal hospital clinic participated in the instrument development (n = 92), reliability (n = 224), and assessment of patient characteristics phases (n = 113) of the study. The DDPRQ was shown to be a reliable, practical instrument. Factor analysis revealed 5 dimensions with face validity. The DDPRQ classified 10.3–20.6% of patient encounters as “difficult” depending on the sample. Demographic characteristics, provider characteristics and most medical diagnoses were not associated with DDPRQ score. In contrast, difficult patients were characterized by psychosomatic symptoms, at least mild personality disorder, and Axis I (major) psychopathology, and most had more than one of these characteristics. The need to identify and understand these components of difficult patient behavior and to include the doctor-patient relationship in strategies for managing the difficult patient is discussed.

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Innerhalb dieser Validierungsstudie zeigten sich insgesamt gute psychometrische Eigenschaften für den GPPR. Im Rahmen des Gesamtprojekts soll ein Retest durchgeführt werden, um die Test-Retest-Reliabilität des Fragebogens zu bestimmen.
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Original articleThe difficult doctor-patient relationship: Somatization, personality and psychopathology

Abstract

Psychosomatics

Psychosomatics

Gaps in doctor patient communication. I: Doctor-patient interaction and patient satisfaction

Pediatrics

Meta-analysis of correlates of provider behavior in medical encounters

Med Care

The difficult patient and the physician-patient relationship

J Fam Pract

Problems and prospects for health services research on provider-patient communications

Med Care

Doctor-patient communication: A review

Clinical hypocompetence: The interview

Ann Intern Med

Troublesome aspects of the patient-physician relationship: A study of human factors

Southern Med J

Attitudes of internal medicine residents and staff physicians toward various patient characteristics

J Med Educ

Patient characteristics that influence physician behavior

Med Care

The difficult patient and the troubled physician

J Fam Pract

Good patients and problem patients: Conformity and deviance in a general hospital

J Health Soc Behav

The problem patient: evaluation and care of medical patients with psychosocial disturbances

Ann Intern Med

Psychiatric symptoms in disliked medical patients

JAMA

The medical care abuser: Differential diagnosis and management

J Fam Pract

Depression ratings in hypochondria

NY State J Med

Medical and psychological characteristics of “crocks”

Int J Psychiatry Med

Original article
The difficult doctor-patient relationship: Somatization, personality and psychopathology