The difficult patient' as perceived by family physicians

Steinmetz, Dov; Tabenkin, Hava

doi:10.1093/fampra/18.5.495

Cited by 163 publications

(130 citation statements)

References 22 publications

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“…Two studies examining physicians' perceptions of walk-in visits found that physicians who considered more encounters to be difficult were more likely to have negative attitudes about psychosocial aspects of care [1,7]. Qualitative research also has identified clinician traits that may contribute to clinicians' tendency to perceive more encounters as difficult, many of which mirror the above findings: limited training in psychosocial care, difficulty setting boundaries, poor communication skills, emotional burnout, exhaustion, and perceived time pressure [8][9][10][11][12][13].…”

Section: Research On the "Difficult Physician"mentioning

confidence: 99%

“…Although age, gender, and specialty do not consistently predict burnout [16,17], limited self-awareness and inability to set professional and personal boundaries do [18]. These self-awareness and boundary challenges are also noted in physicians who perceive more encounters as difficult [8,[10][11][12]. Similarly, both physicians who report high burnout levels and physicians who report more difficult encounters describe their workplaces as characterized by limited control over scheduling and by high workload and time pressure [4][5][6][17][18][19][20].…”

Section: Physician Burnout and Physician-perceived Difficultymentioning

confidence: 99%

“…We are not aware of studies that have identified such "difficult physicians" from a patient or third-party perspective. Instead, research on the physician side of difficult interactions has focused on physicians who report more "difficult patients" or difficult encounters than their colleagues do [1,[4][5][6][7][8][9][10][11][12][13]. Such "difficult doctors" might be more accurately described as physicians with a lower difficulty perception threshold.…”

Section: Introductionmentioning

confidence: 99%

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Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters

Goldsmith

Krebs²

2017

AMA Journal of Ethics

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Physicians are, by definition, contributing partners in "difficult" patientphysician encounters. Although research on relevant physician qualities is limited, common themes mirror the more extensive literature on physician burnout. Focusing on primary care, we discuss physician-level factors in difficult encounters related to psychosocial attitudes and selfawareness, communication skills, and practice environments. Potential approaches to mitigating these factors include changes to medical training, such as structured peer case discussion groups and communication skills development, and changes to workplace environments, such as integrated mental health. Modifying physicianlevel factors in difficult encounters could ease perceived difficulties and improve outcomes for both physicians and patients.

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Section: Research On the "Difficult Physician"mentioning

confidence: 99%

Section: Physician Burnout and Physician-perceived Difficultymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters

Goldsmith

Krebs²

2017

AMA Journal of Ethics

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“…In these patients, the visits last a long time, usually much longer than the average, and the patients tire out their doctors [25]. Here, patients with ADs could enter as one more subgroup.…”

Section: Is the Patient With Ad A Difficult Patient?mentioning

confidence: 99%

"By The Way..."Phenomenon: A Qualitative Study of the Additional Demands in Closing Moments of Medical Interview in Family Medicine

Turabián¹

2017

J Gen Pract

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Objective: To identify and characterize, the additional demands (ADs) in the family medicine practice. Participants and Methods:A qualitative, observational, narrative study, to explore the demand that occur at the end of the visit, with the presentation of a new query motif that is added to the previous one, once this one is finished, from June to August, 2017, in a family medicine office in Toledo, Spain, was carried out, by recording the words used by the patient. From a randomly selected date we included all patients performing additional demand until data saturation. An analysis of the content of the demands collected of each patient included was carried out. The technique to control bias was methodological triangulation between the results obtained with the data that had been reported in the literature.Results: A total of 116 ADs were included, of which 85 (73%) were from female patients and 31 (27%) were from male patients. The age range was 14 to 91 years. The categories that were assessed as with very high or high importance were: 1) What seems to concern or interest the patient more in that moment or it seems to be the most important or the main reason for the doctor at that time, including the consultation on a chronic topic that presents itself as new; 2) What is related or insists in some way on the previous demand and expresses an action to act, or a fear of the previous demand; 3) to sleep or to "nerves"; 4) more than a demand is a story (usually psycho-social); and 5) demand for another family member present or absent in the consultation.

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“…In these, MUS patients are either referred to directly with this label, or indirectly by referring to characteristics said to be typical of these patients. For example, high utilisation of health care services and diverging disease concepts are mentioned as accounting for doctor perceived difficulty [38] - [40]. This is interesting because it demonstrates that the intersection between 'difficult patient' and 'perceived difficulty for the physician' emanates, in part, from the conceptual basis and service context for these conditions.…”

Section: Introductionmentioning

confidence: 99%

What's ‘difficult’? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms

Maatz¹,

Wainwright

Russell

et al. 2016

Journal of Psychosomatic Research

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Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. AbstractBackground The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS.

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The difficult patient' as perceived by family physicians

Cited by 163 publications

References 22 publications

Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters

Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters

"By The Way..."Phenomenon: A Qualitative Study of the Additional Demands in Closing Moments of Medical Interview in Family Medicine

What's ‘difficult’? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms

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