title: Why do doctors find some patients difficult to help?
abstract: Almost all doctors encounter difficulties in managing some patients. Previous studies have examined the characteristics of such patients: we have additionally studied the reasons why hospital doctors find these patients 'difficult to help'. Three clinics (two medical and one surgical) were studied. The consultants rated 60 (22%) of 293 attenders s severely or extremely difficult to help. Difficulty was associated with greater patient distress (odds ratio 3.9; 95% CI 2.0-7.7), less patient satisfaction (2.6; 1.3-5.0) and chronic attendance (5.0; 1.4-17.3). An interview study of 40 'difficult' patients indicated that doctors considered psycho-social factors more important in difficult patients (3.2; 1.3-7.7). Objective differences between the doctor's and the patient's aims for care also occurred more frequently for difficult patients (2.8; 1.1-7.2). Three common types of difficulty were identified; medically unexplained symptoms; co-existing social problems; and severe untreatable illness. A review of the management aims for patients whom doctors find 'difficult to help', combined with improved access to psycho-social care, could improve both the quality and the cost-effectiveness of hospital out-patient services.
authors.affiliation: Department of Psychiatry, University of Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Sharpe
authors.forename: R
authors.initials: R
authors.lastname: Mayou
authors.forename: V
authors.initials: V
authors.lastname: Seagroatt
authors.forename: C
authors.initials: C
authors.lastname: Surawy
authors.forename: H
authors.initials: H
authors.lastname: Warwick
authors.forename: C
authors.initials: C
authors.lastname: Bulstrode
authors.forename: R
authors.initials: R
authors.lastname: Dawber
authors.forename: D
authors.initials: D
authors.lastname: Lane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003253:Consultants; D003657:Decision Making; D003880:Dermatology; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D016017:Odds Ratio; D009985:Orthopedics; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010465:Perception; D010817:Physician-Patient Relations; D015272:Pulmonary Medicine