The difficult patient in private practice physiotherapy: a qualitative study

This qualitative study utilised the nominal group technique to identify a typology of the difficult patient in private practice physiotherapy and to determine strategies physiotherapists use, and would like to improve, when dealing with such patients. The two areas physiotherapists found most difficult to manage were behavioural problems of patients and patient expectations. Few differences were evident regarding ranking of difficult patient attributes between the experienced (n = 19) and less experienced (n = 18) physiotherapists except for the categories of pain and diagnosed psychological problems. While less experienced physiotherapists ranked the pain category highly, experienced physiotherapists did not identify this category. Further, more experienced physiotherapists specifically distinguished between patients with diagnosed psychological problems and patients with psychosocial concerns, while less experienced physiotherapists did not, and placed both these issues into one category. To assist in their interaction with difficult patients, physiotherapists (n = 37) identified that communication skills and behaviour modification techniques were strategies that they would like to learn more about. The results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy.