Difficult Encounters with Psychiatric Patients: A South Texas Psychiatry Practice-based Research Network (PBRN) Study

Randall V. Sellers; Ricardo Salazar; Cervando Martinez; Stephen D. Gelfond; Melissa Deuter; Holly G. Hayes; Norma Ketchum; Brad H. Pollock

doi:10.3122/jabfm.2012.05.120050

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Figure 1.
Data Collection Instrument Completed by Practice-based Research Network (PBRN) Members.

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Table 1. The 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10)

Item^*	Patients Who Rated Difficulty by Item (%)^{^†}
Item^*	Difficult (n = 133)	Not Difficult (n = 772)
1. How much are you looking forward to this patient's next visit (after today)?^{^‡}	92	38
2. How frustrating do you find this patient?	80	9
3. How manipulative is this patient?	46	3
4. To what extent are you frustrated by this patient's vague complaints?	55	4
5. How self-destructive is this patient?	39	6
6. Do you find yourself secretly hoping this patient will not return?	54	2
7. How at ease did you feel with this patient today?^{^‡}	64	18
8. How time-consuming is caring for this patient?	61	10
9. How enthusiastic do you feel about caring for this patient?^{^‡}	90	34
10. How difficult is it to communicate with this patient?	53	6

↵* Each item was scored on a six-point scale: 1 = Not at all, 6 = A great deal.
↵† Based on a DDPR-10 score >30, out of 905 patients. Responses were dichotomized by coding raw scores of 4 through 6 on each item rated as difficult.
↵‡ Item was reversed for scoring (1 = a great deal, 6 = not at all).

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Table 2. Demographic Characteristics by Difficulty Category for 905 Patients with 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) Scores

Characteristics	Difficult^*	Not Difficult
Patients	133 (14.7)	772 (85.3)
Age (years)
≤43	68 (15.5)	372 (84.5)
>43	64 (14.1)	390 (85.9)
Sex
Male	71 (14.1)	431 (85.9)
Female	62 (15.6)	335 (84.4)
Race
White	65 (13.1)	430 (86.9)
Hispanic	43 (15)	244 (85)
Black	15 (24.6)	46 (75.4)
Asian/other	3 (25)	9 (75)
Language issue^{^†}
Yes	8 (33.3)	16 (66.7)
No	92 (12.4)	650 (87.6)
Status^{^‡}
New	24 (22.6)	82 (77.4)
Established	95 (14.5)	561 (85.5)
Setting^{^†}
Office/Outpatient	100 (13.5)	643 (86.5)
Inpatient	25 (25.3)	74 (74.7)
Phone	3 (10.7)	25 (89.3)
Payment^{^‡}
Government (Medicare/Tricare)	81 (16.9)	398 (83.1)
Private insurance	11 (10.2)	97 (89.8)
Self-pay	28 (10)	252 (90)
Appointment duration (min)
<19	30 (15.9)	159 (84.1)
20–30	39 (12.3)	277 (87.7)
45–50	22 (10.6)	186 (89.4)
>51	15 (15.6)	81 (84.4)

Values provided as n (%).
↵* Difficult category contains patients with DDPRQ-10 score >30.
↵† P < .01.
↵‡ P < .05.

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Table 3. Diagnoses and Medication by Difficulty Category for 905 Patients with 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) Scores

	Difficult^*	Not Difficult
Schizophrenia^{^†}	25 (18.8)	54 (7)
Personality disorder^{^†}	48 (36.1)	103 (13.3)
Cognitive disorder^{^‡}	25 (18.8)	78 (10.1)
Alcohol/substance abuse^{^§}	24 (18)	80 (10.4)
ADHD	27 (20.3)	192 (24.9)
Eating disorder	3 (2.3)	5 (0.6)
Bipolar	34 (25.6)	146 (18.9)
Depression^{^‡}	39 (29.3)	329 (42.6)
Axis III symptoms^{^‡}	28 (21.1)	261 (33.8)
Anxiety^{^§}	19 (14.3)	188 (24.4)
PTSD^{^§}	6 (4.5)	84 (10.9)
Psychotherapy^{^‡}	54 (47.4)	436 (61.8)
Psychotherapy with physician^{^†}	20 (20.4)	254 (38.5)
Psychological medications (median [Q1, Q3])^{^§}	3 [1, 3]	2 [1, 3]
Other medications (median [Q1, Q3])^{^‡}	0 [0, 3]	1 [0, 5]

Values provided as n (%) unless otherwise indicated.
↵* Difficult category contains patients with DDPRQ-10 score >30; Not Difficult category contains patients with DDPRQ-10 score ≤30.
↵† P < .001.
↵‡ P < .01.
↵§ P < .05.
ADHD, attention-deficit/hyperactivity disorder; PTSD, posttraumatic stress disorder; Q1, first quartile; Q3, third quartile.