Difficult Doctor-Patient Relationships and Attachment Style in Primary Care

Background and Objective: Physicians experience 10-30% of patient interactions as being interpersonally difficult, but the sources of difficulty are not well understood, despite the frequency of anecdotal studies of the "difficult patient." This study examined whether patients rated as "difficult" by their physicians have more of an insecure attachment style, and whether patients not rated as "difficult" have more of a secure attachment style. Methods: The participants were 100 primary care patients and 28 physicians from a university-based family medicine residency training program in a suburb of Detroit, Michigan, USA. Results: The results revealed that, while adjusting for the patients' age, education, and income, fearful attachment and the physician's rating of the patient's overall health were significantly associated with the physician's perception of patient difficulty. Conclusions: This study suggests that residency training should include behavioral science education in the assessment and management of insecure attachment styles to ensure that such patients receive optimal care and support the mission of primary care medicine.