Frustrating patients: physician and patient perspectives among distressed high users of medical services.
OBJECTIVE
To identify differences between patients viewed as frustrating by their physicians and those considered typical and satisfying.


METHODS
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.


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


METHODS
Study patients were in the top decile for ambulatory visits, and bad 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.


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.
Lin
E H
EH
Department of Health Services, University of Washington School of Public Health, Seattle.
Katon
W
W
Von Korff
M
M
Bush
T
T
Lipscomb
P
P
Russo
J
J
Wagner
E
E
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D005639:Frustration; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data; D011897:Random Allocation; D011795:Surveys and Questionnaires