Abstract
PURPOSE: To investigate the experience of chronic unhappiness as it presents in family practice. DESIGN: A descriptive, qualitative study of both patients and physicians using an existential phenomenologic approach. SETTING: Two village general practices in South Africa. PARTICIPANTS: Four patients who were difficult, "heartsink" patients, who gave their doctors an overwhelming feeling of exasperation and defeat. METHOD: We investigated the clinical records thoroughly and explored patients' relationships with others. Through interpretation and reflection, we tried to discover what role the doctor could play with these patients. FINDINGS: Chronic unhappiness was found to be not only a condition of life for the patients but also for the doctor. It was an important factor in the relationship they shared. Unhappiness was revealed in part by frequent visits by the patients, a constellation of negative feelings in the doctor, and difficult patient-doctor relationships. CONCLUSION: Chronic unhappiness is not "treatable" in the normal curative or therapeutic sense. This does not prevent our quest to diagnose and cure, but enlarges our horizons to recognizing and accepting our own human reactions to patients and understanding how we can meet their needs.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anstett R. The difficult patient and the physician-patient relationship. J Fam Pract. 1980 Aug;11(2):281–286. [PubMed] [Google Scholar]
- Berner P., Musalek M., Walter H. Psychopathological concepts of dysphoria. Psychopathology. 1987;20(2):93–100. doi: 10.1159/000284485. [DOI] [PubMed] [Google Scholar]
- Cassel E. J. The nature of suffering and the goals of medicine. N Engl J Med. 1982 Mar 18;306(11):639–645. doi: 10.1056/NEJM198203183061104. [DOI] [PubMed] [Google Scholar]
- Chrzanowski G. Problem patients or troublemakers? Dynamic and therapeutic considerations. Am J Psychother. 1980 Jan;34(1):26–38. doi: 10.1176/appi.psychotherapy.1980.34.1.26. [DOI] [PubMed] [Google Scholar]
- Ellis C. G. Dysphoria, a non-disease. S Afr Med J. 1987 Jan 24;71(2):69–70. [PubMed] [Google Scholar]
- Gerrard T. J., Riddell J. D. Difficult patients: black holes and secrets. BMJ. 1988 Aug 20;297(6647):530–532. doi: 10.1136/bmj.297.6647.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Groves J. E. Taking care of the hateful patient. N Engl J Med. 1978 Apr 20;298(16):883–887. doi: 10.1056/NEJM197804202981605. [DOI] [PubMed] [Google Scholar]
- O'Dowd T. C. Five years of heartsink patients in general practice. BMJ. 1988 Aug 20;297(6647):528–530. doi: 10.1136/bmj.297.6647.528. [DOI] [PMC free article] [PubMed] [Google Scholar]