HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Rapid Responses: Submit a response Rapid Responses: View responses Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Elder, N. Articles by Tobias, B. Search for Related Content PubMed PubMed Citation Articles by Elder, N. Articles by Tobias, B.

How Respected Family Physicians Manage Difficult Patient Encounters

From the Department of Family Medicine, University of Cincinnati, Cincinnati, OH

Correspondence: Corresponding author: Nancy C. Elder, MD, MSPH, Department of Family Medicine, University of Cincinnati, PO Box 670582, Cincinnati, OH 45267-0582 (E-mail: eldernc{at}fammed.uc.edu)

Background: Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping.

Objective: To describe how respected family physicians identify, manage, and cope with difficult patient encounters.

Methods: Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes.

Results: 102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians’ personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy.

Conclusions: We propose a model where clashes between patient behaviors and physicians’ traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.