title: [Difficult encounters in primary care: A multifocal perspective].
abstract: BACKGROUND
  The main objective of the study is to analyze the perception of difficult encounters experienced by the various professional groups involved in patient care.
  
  
  METHODS
  The methodology used is qualitative, using focus groups. Four groups were formed: doctors, nurses, primary care receptionists, and experts in communication skills. The location was primary care, in Ourense area. Sampling was purposive. Patients were recruited by a member of the same professional group. Each session was recorded on audio and video. Information was categorized by reference to the bibliography and information resulting from conversations.
  
  
  RESULTS
  The following categories were established: the concept of a difficult patient/difficult encounter, reasons for difficulty, consequences for the professional and patient, individual strategies of management, and strategies that institutions should take. The concept of difficulty varies among the different groups. All are capable of recognizing the professional responsibility, but this aspect does not arise spontaneously, except in the group of experts. In relation to difficult encounter management, most express strategies based on common sense and experience. The expert group uses more sophisticated techniques.
  
  
  CONCLUSIONS
  There are differences in the quality of discourse and positioning relative to the user from the group of experts and other groups. Training in communication techniques is recommended to encourage a change in attitudes towards a patient-centered code, but the content of training should be developed based on knowledge of the group to which they are addressed.
authors.affiliation: Servicio de Atención Primaria de Allariz, Servicio Gallego de Salud (SERGAS), Ourense, España. Electronic address: Roberto.Fernandez.Alvarez@sergas.es.
authors.forename: R
authors.initials: R
authors.lastname: Fernández
authors.affiliation: Universidad de Valladolid, Valladolid, España.
authors.forename: M
authors.initials: M
authors.lastname: Menéndez
authors.affiliation: Punto de Atención Continuada de Ourense, Servicio Gallego de Salud (SERGAS), Ourense, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Fernández
authors.affiliation: Servicio de Atención Primaria de Lalín, Servicio Gallego de Salud (SERGAS), Pontevedra, España.
authors.forename: M
authors.initials: M
authors.lastname: Pérez
authors.affiliation: Servicio de Urgencias, Complejo Hospitalario Universitario de Ourense, Servicio Gallego de Salud (SERGAS), Ourense, España.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Novo
authors.affiliation: Servicio de Atención Primaria de Allariz, Servicio Gallego de Salud (SERGAS), Ourense, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Álvarez
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011369:Professional-Patient Relations
keywords: Atención primaria; Difficult encounters; Difficult patient; Encuentro difícil; Estudio cualitativo; Paciente difícil; Primary care; Qualitative study