Journal of General Internal Medicine

, Volume 6, Issue 3, pp 241–246 | Cite as

Frustrating patients

Physician and patient perspectives among distressed high users of medical services
  • Elizabeth H. B. Lin
  • Wayne Katon
  • Michael Von Korff
  • Terry Bush
  • Patricia Lipscomb
  • Joan Russo
  • Ed Wagner
Original Articles


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 


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Copyright information

© Glaxo Inc 1987

Authors and Affiliations

  • Elizabeth H. B. Lin
    • 1
  • Wayne Katon
    • 2
  • Michael Von Korff
    • 1
  • Terry Bush
    • 1
  • Patricia Lipscomb
    • 2
  • Joan Russo
    • 2
  • Ed Wagner
    • 1
  1. 1.the Center for Health Studies, Group Health Cooperative of Puget Sound, Department of Health ServicesUniversity of Washington School of Public HealthSeattle
  2. 2.the Department of Psychiatry and Behavioral SciencesUniversity of Washington Medical SchoolSeattle

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