The difficult patient and the troubled physician

Area of Science:

• Medical Sociology
• Physician Well-being
• Patient-Physician Relationship

Background:

• Physician emotional responses to patient encounters can influence medical care outcomes.
• Understanding these "troubling feelings" is crucial for improving physician well-being and patient care.
• Sources of physician frustration, anger, guilt, and dissatisfaction need identification.

Purpose of the Study:

• To quantify the frequency of troubling emotions experienced by physicians during patient encounters.
• To identify patient-related factors (e.g., psychosocial problems, social class) associated with these emotions.
• To investigate the relationship between physician experience and the occurrence of troubling encounters.

Main Methods:

• Twelve community physicians with similar training and practice settings participated.
• A total of 722 patient encounters were evaluated for the presence of physician "troubling emotions."
• Data were collected on patient characteristics, including psychosocial issues and social class.

Main Results:

• Approximately 30% of evaluated patient encounters were "troubling" to the physicians.
• Patient encounters involving psychosocial problems or patients of lower social class led to significantly more troubling emotions.
• Physicians with greater experience reported significantly fewer troubling encounters.

Conclusions:

• Physician emotional responses are a notable factor in a significant portion of patient encounters.
• Specific patient characteristics, namely psychosocial difficulties and lower social class, are linked to increased physician emotional burden.
• Clinical experience appears to be a protective factor, reducing the frequency of troubling encounters for physicians.