Organic brain dysfunction and the difficult patient

Sixteen patients considered "difficult" by the staff of a family practice center were matched for age and sex with sixteen "average" patients, and both groups were tested on two standard indicators of organic brain dysfunction. Both groups of patients showed abnormal impairment of visual-motor coordination, with greater impairment among the difficult patients. Difficult patients showed significantly greater impairment of verbal abstract reasoning, indicating problems with cognitive skills. These findings suggest the presence of organic brain dysfunction among the difficult patients, yet none carried a diagnostic listing or hypothesis of organicity. With the current emphasis upon the "biopsychosocial" medical model, patients with organic brain impairment may be mislabeled with psychiatric or psychosocial diagnoses.