TY - JOUR
T1 - How respected family physicians manage difficult patient encounters
AU - Elder, Nancy
AU - Ricer, Rick
AU - Tobias, Barbara
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2006/11
Y1 - 2006/11
N2 - Background: Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping. Objective: To describe how respected family physicians identify, manage, and cope with difficult patient encounters. Methods: Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes. Results: 102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians' personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy. Conclusions: We propose a model where clashes between patient behaviors and physicians' traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.
AB - Background: Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping. Objective: To describe how respected family physicians identify, manage, and cope with difficult patient encounters. Methods: Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes. Results: 102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians' personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy. Conclusions: We propose a model where clashes between patient behaviors and physicians' traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.
UR - http://www.scopus.com/inward/record.url?scp=33750947658&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33750947658&partnerID=8YFLogxK
U2 - 10.3122/jabfm.19.6.533
DO - 10.3122/jabfm.19.6.533
M3 - Article
C2 - 17090786
AN - SCOPUS:33750947658
SN - 1557-2625
VL - 19
SP - 533
EP - 541
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 6
ER -