Abstract
Dealing with difficult patients can represent a significant burden in the life of doctors. It is more productive, however, to view this burden as a product of the interaction between doctor and patient, for which both have a responsibility, rather than attributing any problems encountered to shortcomings of the patient alone. There is a significant risk in such situations of potentially harmful over-medicalisation. It behoves doctors, therefore, to try to prevent such problems becoming established, or make some attempt to rectify matters if they have already become so. Much is known about the factors that contribute to successful and unsuccessful clinical transactions. The awareness of what doctors bring both as professionals and as individual people to this interaction, will count as much as the practical clinical efforts made towards helping patients.
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- Adler G. Helplessness in the helpers. Br J Med Psychol. 1972 Dec;45(4):315–326. doi: 10.1111/j.2044-8341.1972.tb02214.x. [DOI] [PubMed] [Google Scholar]
- Anstett R. The difficult patient and the physician-patient relationship. J Fam Pract. 1980 Aug;11(2):281–286. [PubMed] [Google Scholar]
- Baughan D. M., Revicki D., Nieman L. Z. Management of problem patients with multiple chronic diseases. J Fam Pract. 1983 Aug;17(2):233–239. [PubMed] [Google Scholar]
- Bridges K., Goldberg D., Evans B., Sharpe T. Determinants of somatization in primary care. Psychol Med. 1991 May;21(2):473–483. doi: 10.1017/s0033291700020584. [DOI] [PubMed] [Google Scholar]
- Bucks R. S., Williams A., Whitfield M. J., Routh D. A. Towards a typology of general practitioners' attitudes to general practice. Soc Sci Med. 1990;30(5):537–547. doi: 10.1016/0277-9536(90)90152-i. [DOI] [PubMed] [Google Scholar]
- Calnan M. Images of general practice: the perceptions of the doctor. Soc Sci Med. 1988;27(6):579–586. doi: 10.1016/0277-9536(88)90005-6. [DOI] [PubMed] [Google Scholar]
- Cohen J. Diagnosis and management of problem patients in general practice. J R Coll Gen Pract. 1987 Feb;37(295):51–51. [PMC free article] [PubMed] [Google Scholar]
- Corney R. H., Strathdee G., Higgs R., King M., Williams P., Sharp D., Pelosi A. J. Managing the difficult patient: practical suggestions from a study day. J R Coll Gen Pract. 1988 Aug;38(313):349–352. [PMC free article] [PubMed] [Google Scholar]
- Crutcher J. E., Bass M. J. The difficult patient and the troubled physician. J Fam Pract. 1980 Nov;11(6):933–938. [PubMed] [Google Scholar]
- ENGEL G. L. A unified concept of health and disease. Perspect Biol Med. 1960;3:459–485. doi: 10.1353/pbm.1960.0020. [DOI] [PubMed] [Google Scholar]
- Fabrega H., Jr The concept of somatization as a cultural and historical product of Western medicine. Psychosom Med. 1990 Nov-Dec;52(6):653–672. doi: 10.1097/00006842-199011000-00007. [DOI] [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]
- Grol R., de Maeseneer J., Whitfield M., Mokkink H. Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and The Netherlands. Fam Pract. 1990 Jun;7(2):100–103. doi: 10.1093/fampra/7.2.100. [DOI] [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]
- Hall J. A., Roter D. L., Katz N. R. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988 Jul;26(7):657–675. doi: 10.1097/00005650-198807000-00002. [DOI] [PubMed] [Google Scholar]
- Hall J. A., Roter D. L., Katz N. R. Task versus socioemotional behaviors in physicians. Med Care. 1987 May;25(5):399–412. doi: 10.1097/00005650-198705000-00004. [DOI] [PubMed] [Google Scholar]
- Horder J., Moore G. T. The consultation and health outcomes. Br J Gen Pract. 1990 Nov;40(340):442–443. [PMC free article] [PubMed] [Google Scholar]
- John C., Schwenk T. L., Roi L. D., Cohen M. Medical care and demographic characteristics of 'difficult' patients. J Fam Pract. 1987 Jun;24(6):607–610. [PubMed] [Google Scholar]
- Katon W., Kleinman A., Rosen G. Depression and somatization: a review. Part I. Am J Med. 1982 Jan;72(1):127–135. doi: 10.1016/0002-9343(82)90599-x. [DOI] [PubMed] [Google Scholar]
- Kuch J. H., Schuman S. S., Curry H. B. The problem patient and the problem doctor or do quacks make crocks? J Fam Pract. 1977 Oct;5(4):647–653. [PubMed] [Google Scholar]
- Lipowski Z. J. Somatization: the concept and its clinical application. Am J Psychiatry. 1988 Nov;145(11):1358–1368. doi: 10.1176/ajp.145.11.1358. [DOI] [PubMed] [Google Scholar]
- MECHANIC D. The concept of illness behavior. J Chronic Dis. 1962 Feb;15:189–194. doi: 10.1016/0021-9681(62)90068-1. [DOI] [PubMed] [Google Scholar]
- McGaghie W. C., Whitenack D. C. A scale for measurement of the problem patient labeling process. J Nerv Ment Dis. 1982 Oct;170(10):598–604. doi: 10.1097/00005053-198210000-00003. [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]
- Pilowsky I. Abnormal illness behaviour. Br J Med Psychol. 1969 Dec;42(4):347–351. doi: 10.1111/j.2044-8341.1969.tb02089.x. [DOI] [PubMed] [Google Scholar]
- Savage R., Armstrong D. Effect of a general practitioner's consulting style on patients' satisfaction: a controlled study. BMJ. 1990 Oct 27;301(6758):968–970. doi: 10.1136/bmj.301.6758.968. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schrire S. Frequent attenders--a review. Fam Pract. 1986 Dec;3(4):272–275. doi: 10.1093/fampra/3.4.272. [DOI] [PubMed] [Google Scholar]
- Sharpe M., Mayou R., Seagroatt V., Surawy C., Warwick H., Bulstrode C., Dawber R., Lane D. Why do doctors find some patients difficult to help? Q J Med. 1994 Mar;87(3):187–193. [PubMed] [Google Scholar]