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

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298:883–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Drossman DA. The problem patient: evaluation and care of medical patients with psychosocial disturbances. Ann Intern Med. 1978;88:366–72.PubMedGoogle Scholar
  3. 3.
    Von Mering O, Earley LW. The ambulatory problem patient: a unique teaching resource. Am J Psychiatry. 1969;126:108–12.Google Scholar
  4. 4.
    Malcolm R, Foster HK, Smith C. The problem patient as perceived by family physicians. J Fam Pract. 1977;5:361–4.PubMedGoogle Scholar
  5. 5.
    Chrzanowski G. Problem patients or troublemakers? Dynamic and therapeutic considerations. Am J Psychother. 1980;34:26–38.PubMedGoogle Scholar
  6. 6.
    Anstett R. The difficult patient and the physician — patient relationship. J Fam Pract. 1980;11:281–6.PubMedGoogle Scholar
  7. 7.
    Gerrard TJ, Riddell JD. Difficult patients; black holes and secrets. Br Med J. 1988;297;530–2.Google Scholar
  8. 8.
    Goodwin JM, Goodwin JS, Kellner R. Psychiatric symptoms in disliked medical patients. JAMA. 1979;241:1117–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Crutcher JE, Bass MJ. The difficult patient and the troubled physician. J Fam Pract. 1980;11:933–8.PubMedGoogle Scholar
  10. 10.
    Schwenk TL, Marquez JT, Lefever D, Cohen M. Physician and patient determinants of difficult physician — patient relationships. J Fam Pract. 1989;28:59–63.PubMedCrossRefGoogle Scholar
  11. 11.
    John C, Schwenk TL, Roi LD, Cohen M. Medical care and demographic characteristics of difficult patients. J Fam Pract. 1987;24:607–10.PubMedGoogle Scholar
  12. 12.
    Robins LN, Helzer J, Croughan J, Ratcliff KS. The National Institute of Mental Health Diagnostic Interview Schedule: its history, characeristics and validity. Arch Gen Psychiatry. 1981;38:381–9.PubMedGoogle Scholar
  13. 13.
    American Psychiatric Association. Diagnosic and Statistical Manual of Mental Disorders. (3rd ed revised) DSM-III-R. Washington, DC: APA, 1987.Google Scholar
  14. 14.
    Derogatis LR, Rickels K, Ulenhuth EH, Covi L. The Hopkins Symptom Checklist: a measure of primary symptom dimensions. In: Pichot P, ed. Psychological measurements in psychopharmacology: problems in pharmacopsychiatry. Basel: S. Karger, Switzerland 1974;7:79–110.Google Scholar
  15. 15.
    Belloc NB, Breslow L. Hochstim DJ. Measurement of physical health in a general population survey. Am J Epidemiology. 1971;193:328–36.Google Scholar
  16. 16.
    Escobar JI, Burnam MA, Karno M, Forsythe A, Golding HM. Somatization in the community. Arch Gen Psychiatry. 1987;44:713–8.PubMedGoogle Scholar
  17. 17.
    Katon W, Von Korff M, Lin EHB, et al. Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12:355–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Katon W, Kleinman Am, Rosen G. Depression and somatization: a review. Am J Med. 1982;72:127–35, 241–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Kleinman AM, Kleinman J. Somatization. In: Kleinman A, Good B, eds. Culture and depression. Berkeley, California: University of California, 1985;429–90.Google Scholar
  20. 20.
    Katon W, Lin EHB, Von Korff M, et al. Somatization: a spectrum of severity. Am J Psychiatry. 1991 (in press).Google Scholar
  21. 21.
    Escobar JI, Golding JM, Hough RL, Karno M, Burnam MA, Wells KB. Somatization in the community: relationship to disability and use of services. Am J Public Health. 1987;77:837–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Barsky AJ, Wyshak G, Klerman GL. Hypochondriacs, doctors, and medical care. 1991 (in press).Google Scholar
  23. 23.
    Zinn WM. Doctors have feelings too. JAMA. 1988;259:3296–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Kleinman AM, Eisenberg L, Good B. Culture, illness and care. Ann Intern Med. 1978;88:251–8.PubMedGoogle Scholar
  25. 25.
    Quill TE. Somatization disorder: one of medicine’s blind spots. JAMA. 1985;254:3075–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Katon W, Roy-Byrne PP. Antidepressants in the medically ill: diagnosis and treatment in primary care. Clin Chemistry. 1988;34:829–36.Google Scholar
  27. 27.
    Katon W. Panic disorder: epidemiology, diagnosis, and treatment in primary care. J Clin Psychiatry. 1986;47:21–7.PubMedGoogle Scholar
  28. 28.
    Smith RG, Monson RA, Ray DC. Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med. 1986;314:1407–13.PubMedCrossRefGoogle Scholar

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

Personalised recommendations