title: Difficult encounters with psychiatric patients: a South Texas Psychiatry practice-based research network (PBRN) study.
abstract: OBJECTIVE
  To examine the prevalence of difficult psychiatrist-patient interactions of 20 psychiatrists in the South Texas Psychiatric practice-based research network, determine what characteristics were associated with "difficult" patients, and compare findings with previous studies in primary care.
  
  
  METHODS
  During a 2-month observational study, psychiatrists collected patient information on setting, demographics, diagnoses, and medications and rated the patients using the Difficult Doctor-Patient Relationship Questionnaire, which had previously been used and validated in the primary care setting.
  
  
  RESULTS
  A total of 905 valid data cards were collected. Difficult patients were identified in 15% of the sample. Diagnoses of schizophrenia, alcohol/substance abuse, and personality disorder were associated with difficulty. Psychiatrists least burdened by difficult patients were older and in a solo practice and worked 51 to 55 hours per week.
  
  
  CONCLUSIONS
  This cross-sectional study demonstrates that psychiatrists encounter difficult patients at a rate (15%) similar to that of primary care physicians. Mentoring programs and structured treatment interventions for the most difficult patient groups may assist all physicians who treat psychiatric patients, whether in specialty, family medicine, or other primary care settings.
authors.affiliation: South Texas Psychiatric Practice-Based Research Network, San Antonio, TX, USA.
authors.forename: Randall V
authors.initials: RV
authors.lastname: Sellers
authors.forename: Ricardo
authors.initials: R
authors.lastname: Salazar
authors.forename: Cervando
authors.initials: C
authors.lastname: Martinez
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Gelfond
authors.forename: Melissa
authors.initials: M
authors.lastname: Deuter
authors.forename: Holly G
authors.initials: HG
authors.lastname: Hayes
authors.forename: Norma
authors.initials: N
authors.lastname: Ketchum
authors.forename: Brad H
authors.initials: BH
authors.lastname: Pollock
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011570:Psychiatry; D036301:Qualitative Research; D013781:Texas