title: Doctors, "dirty work" patients, and "revolving doors".
abstract: Using information from research into the phenomenon of "revolving-door" psychiatric patients, the author explores general practitioners' perceptions of difficult patients and the consequences for patient management. He first considers the concept of "good and bad" as a possible subtype of dirty work. He then presents the evidence of medical irritation with patients from interview data and explores the rationalizations for the way in which patients are subsequently managed. In line with previous studies, the author argues that the construction of patients as difficult and the subsequent dynamics of exclusion lie in the breakdown of the "normal" doctor-patient relationship coupled with the doctor's need to get on with the day's workload. Moral judgments formed a part of the exclusion process.
authors.affiliation: Centre for Research in Medical Sociology and Health Policy, University of Nottingham, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Shaw
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010817:Physician-Patient Relations; D012803:Sick Role; D017211:Treatment Failure; D006113:United Kingdom