title: Challenges in primary care relationships: seeing it from both sides.
abstract: OBJECTIVE
  This qualitative study explored perspectives of primary care providers and patients in challenging relationships.
  
  
  METHODS
  In 2007, we conducted semi-structured interviews with providers recruited from 12 clinics affiliated with a U.S. academic center. Providers identified patients with whom they had ongoing "challenging relationships," and we interviewed the first consenting patient for each provider. We compared numeric ratings of relationship quality statistically. Using an editing analysis style, ≥2 investigators coded transcripts to identify themes.
  
  
  RESULTS
  Seventeen dyads participated. Providers averaged 14 years in practice. Most were Caucasian (88%) and female (59%). The mean patient age was 49 years, 59% were Caucasian, and 71% female. Relationships averaged 4.6 years. On a 1-10 scale, patients' ratings of the relationship quality (median 9) significantly exceeded providers' ratings (median 5, p=0.002). Three major themes emerged: patients view relationships more positively than providers, the challenges of guarding emotions, and trust matters in challenging relationships.
  
  
  CONCLUSIONS
  Patients felt more positively about these relationships than providers perceived. Both sought ways to achieve mutual trust, despite barriers arising from guarded emotions.
  
  
  CONCLUSIONS
  Providers in challenging relationships should consider exploring their patients' views, as they may feel reassured that patients appreciate their efforts and have trust in them.
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, Center for Vulnerable Populations, University of California, San Francisco 94110, USA. ratanawongsan@medsfgh.ucsf.edu
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wright
authors.forename: Edith M
authors.initials: EM
authors.lastname: Vargo
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carrese
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015142:Baltimore; D005260:Female; D005639:Frustration; D006300:Health Services Misuse; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009723:Nurse-Patient Relations; D059408:Pain Management; D010817:Physician-Patient Relations; D011320:Primary Health Care; D013001:Somatoform Disorders / Q000628:therapy; D035502:Trust