title: ["Difficult encounters" in primary care clinic: a patient and doctor perspective].
abstract: OBJECTIVE
  To find out the prevalence and causes of "difficult encounters" (DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed.
  
  
  METHODS
  Cross-sectional, descriptive.
  
  
  METHODS
  Urban health centre.
  
  
  METHODS
  Four doctors, their 4 residents and patients who went to their clinics (March-May 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire.
  
  
  METHODS
  sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a "difficult professional" (DP) by the patient.
  
  
  RESULTS
  There were 415 visits; 352 questionnaires (85% participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5% according to doctors (95% CI, 5.8-11.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1% according to the patients (95% CI, 1.6-5.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81% of cases. CDE insignificant (kappa=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95% CI, 3.1-8); 53 (15.1%) had changed at some point for this reason (95% CI, 11.3-18.8) and 11 (3.1%) considered their doctor to be DP (95% CI, 1.6-5.5).
  
  
  CONCLUSIONS
  The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP.
authors.affiliation: Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España. 22716xmg@comb.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Mas Garriga
authors.forename: Montserrat
authors.initials: M
authors.lastname: Navarro Gilo
authors.forename: Judit
authors.initials: J
authors.lastname: Vázquez Morocho
authors.forename: Cristina
authors.initials: C
authors.lastname: Delso Gafarot
authors.forename: Tarek
authors.initials: T
authors.lastname: Mahfouz Castejón
authors.forename: Jesús
authors.initials: J
authors.lastname: Almeda Ortega
mesh_terms: D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires