Who Is Being Difficult? Addressing the Determinants of Difficult Patient-Physician Relationships

Abstract

Both the patient and physician bring to the medical encounter social and personal characteristics that contribute to defining the nature of the patient-physician relationship. When patient or physician or both feel frustrated with the medical encounter, the situation may lead to poorer health outcomes. In a 1989 article in the Journal of Family Practice, Thomas L. Schwenk, MD, et al cite several studies that address the difficult patient-physician relationship by looking at characteristics of patients who have been labeled difficult by physicians [1-5]. These so-called difficult patients are seen as demanding, non-compliant, manipulative, and self-destructive [6]. But focusing on just the patient member of the dyad gives the illusion that the patient is the wrongdoer in the relationship. A physician who wishes to ease the troubled relationship, may turn to a catalog of psychological conditions as explanations for the patients' behaviors. This solution is limited and does not consider the influence of the physicians' roles in the relationships.Schwenk et al also illustrate how differing physician and patient expectations can produce mutually negative outcomes in the medical encounter [7]. In "Physician and Patient Determinants of Difficult Physician-Patient Relationships," the authors explain that among the family physicians they surveyed the primary motivations for practicing medicine were the desire to help people and the attraction to the problem-solving challenges specific to medicine. When these goals are not met in dealing with a particular patient, the physician is apt to think of that patient as "difficult."

Coping with cancer and a history of health-related events

“…Manifestations of anger, such as yelling or accusations (e.g. blaming the healthcare service for the disease contracted) as well as irritation, may, according to Groves’ typology [ 18 ], contribute to classifying an individual as a litigious patient (colloquially, a “difficult” patient). Socially unacceptable anger in this case serves no other purpose than to mask helplessness, fear and anxiety, as well as concerns about the treatment of the disease.…”