Journal of General Internal Medicine

, Volume 6, Issue 3, pp 241–246

Frustrating patients

Physician and patient perspectives among distressed high users of medical services

Authors

  • Elizabeth H. B. Lin
    • the Center for Health Studies, Group Health Cooperative of Puget Sound, Department of Health ServicesUniversity of Washington School of Public Health
  • Wayne Katon
    • the Department of Psychiatry and Behavioral SciencesUniversity of Washington Medical School
  • Michael Von Korff
    • the Center for Health Studies, Group Health Cooperative of Puget Sound, Department of Health ServicesUniversity of Washington School of Public Health
  • Terry Bush
    • the Center for Health Studies, Group Health Cooperative of Puget Sound, Department of Health ServicesUniversity of Washington School of Public Health
  • Patricia Lipscomb
    • the Department of Psychiatry and Behavioral SciencesUniversity of Washington Medical School
  • Joan Russo
    • the Department of Psychiatry and Behavioral SciencesUniversity of Washington Medical School
  • Ed Wagner
    • the Center for Health Studies, Group Health Cooperative of Puget Sound, Department of Health ServicesUniversity of Washington School of Public Health
Original Articles

DOI: 10.1007/BF02598969

Cite this article as:
Lin, E.H.B., Katon, W., Von Korff, M. et al. J Gen Intern Med (1991) 6: 241. doi:10.1007/BF02598969

Abstract

Objective:To identify differences between patients viewed as frustrating by their physicians and those considered typical and satisfying.

Design:This cross-sectional observational study focused on psychologically distressed high users of medical services. Frustrating patients were compared with typical and satisfying patients, using data from patient questionnaires, physician assessments, structured psychiatric interviews, and computerized utilization records.

Setting:Group Health Cooperative of Puget Sound, a large health maintenance organization.

Patients/participants:Study patients were in the top decile for ambulatory visits, and had elevated scores for anxiety, depression, and somatization. Among the 339 patients invited to participate in the study, 251 agreed, and 228 were rated by their physicians.

Main results:A substantial proportion (37%) of the high users were viewed as frustrating by their physicians. Physicians’ ratings of physical disease severity did not differ among the groups, but frustrating patients rated their own health status less favorably and reported more somatic symptoms and disabilities. The frustrating group utilized more medical services than did other distressed high utilizers. All three groups had a high prevalence of mental disorders. However, frustrating patients had higher rates of somatization and generalized anxiety disorder.

Conclusions:Physicians and their frustrating patients had contrasting views of the patients’ illnesses. The best predictors of physician frustration were somatization and increased medical service utilization. There is need for further research and clinical attention concerning optimal clinical management for patients with somatization.

Key words

frustrating patients somatization medical services utilization

Copyright information

© Glaxo Inc 1987