Skip to main content
Log in

Frustrating patients

Physician and patient perspectives among distressed high users of medical services

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Objective:To identify differences between patients viewed as frustrating by their physicians and those considered typical and satisfying.

Design:This cross-sectional observational study focused on psychologically distressed high users of medical services. Frustrating patients were compared with typical and satisfying patients, using data from patient questionnaires, physician assessments, structured psychiatric interviews, and computerized utilization records.

Setting:Group Health Cooperative of Puget Sound, a large health maintenance organization.

Patients/participants:Study patients were in the top decile for ambulatory visits, and had elevated scores for anxiety, depression, and somatization. Among the 339 patients invited to participate in the study, 251 agreed, and 228 were rated by their physicians.

Main results:A substantial proportion (37%) of the high users were viewed as frustrating by their physicians. Physicians’ ratings of physical disease severity did not differ among the groups, but frustrating patients rated their own health status less favorably and reported more somatic symptoms and disabilities. The frustrating group utilized more medical services than did other distressed high utilizers. All three groups had a high prevalence of mental disorders. However, frustrating patients had higher rates of somatization and generalized anxiety disorder.

Conclusions:Physicians and their frustrating patients had contrasting views of the patients’ illnesses. The best predictors of physician frustration were somatization and increased medical service utilization. There is need for further research and clinical attention concerning optimal clinical management for patients with somatization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298:883–7.

    Article  PubMed  CAS  Google Scholar 

  2. Drossman DA. The problem patient: evaluation and care of medical patients with psychosocial disturbances. Ann Intern Med. 1978;88:366–72.

    PubMed  CAS  Google Scholar 

  3. Von Mering O, Earley LW. The ambulatory problem patient: a unique teaching resource. Am J Psychiatry. 1969;126:108–12.

    Google Scholar 

  4. Malcolm R, Foster HK, Smith C. The problem patient as perceived by family physicians. J Fam Pract. 1977;5:361–4.

    PubMed  CAS  Google Scholar 

  5. Chrzanowski G. Problem patients or troublemakers? Dynamic and therapeutic considerations. Am J Psychother. 1980;34:26–38.

    PubMed  CAS  Google Scholar 

  6. Anstett R. The difficult patient and the physician — patient relationship. J Fam Pract. 1980;11:281–6.

    PubMed  CAS  Google Scholar 

  7. Gerrard TJ, Riddell JD. Difficult patients; black holes and secrets. Br Med J. 1988;297;530–2.

    CAS  Google Scholar 

  8. Goodwin JM, Goodwin JS, Kellner R. Psychiatric symptoms in disliked medical patients. JAMA. 1979;241:1117–20.

    Article  PubMed  CAS  Google Scholar 

  9. Crutcher JE, Bass MJ. The difficult patient and the troubled physician. J Fam Pract. 1980;11:933–8.

    PubMed  CAS  Google Scholar 

  10. Schwenk TL, Marquez JT, Lefever D, Cohen M. Physician and patient determinants of difficult physician — patient relationships. J Fam Pract. 1989;28:59–63.

    Article  PubMed  CAS  Google Scholar 

  11. John C, Schwenk TL, Roi LD, Cohen M. Medical care and demographic characteristics of difficult patients. J Fam Pract. 1987;24:607–10.

    PubMed  CAS  Google Scholar 

  12. Robins LN, Helzer J, Croughan J, Ratcliff KS. The National Institute of Mental Health Diagnostic Interview Schedule: its history, characeristics and validity. Arch Gen Psychiatry. 1981;38:381–9.

    PubMed  CAS  Google Scholar 

  13. American Psychiatric Association. Diagnosic and Statistical Manual of Mental Disorders. (3rd ed revised) DSM-III-R. Washington, DC: APA, 1987.

    Google Scholar 

  14. Derogatis LR, Rickels K, Ulenhuth EH, Covi L. The Hopkins Symptom Checklist: a measure of primary symptom dimensions. In: Pichot P, ed. Psychological measurements in psychopharmacology: problems in pharmacopsychiatry. Basel: S. Karger, Switzerland 1974;7:79–110.

    Google Scholar 

  15. Belloc NB, Breslow L. Hochstim DJ. Measurement of physical health in a general population survey. Am J Epidemiology. 1971;193:328–36.

    Google Scholar 

  16. Escobar JI, Burnam MA, Karno M, Forsythe A, Golding HM. Somatization in the community. Arch Gen Psychiatry. 1987;44:713–8.

    PubMed  CAS  Google Scholar 

  17. Katon W, Von Korff M, Lin EHB, et al. Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12:355–62.

    Article  PubMed  CAS  Google Scholar 

  18. Katon W, Kleinman Am, Rosen G. Depression and somatization: a review. Am J Med. 1982;72:127–35, 241–7.

    Article  PubMed  CAS  Google Scholar 

  19. Kleinman AM, Kleinman J. Somatization. In: Kleinman A, Good B, eds. Culture and depression. Berkeley, California: University of California, 1985;429–90.

    Google Scholar 

  20. Katon W, Lin EHB, Von Korff M, et al. Somatization: a spectrum of severity. Am J Psychiatry. 1991 (in press).

  21. Escobar JI, Golding JM, Hough RL, Karno M, Burnam MA, Wells KB. Somatization in the community: relationship to disability and use of services. Am J Public Health. 1987;77:837–40.

    Article  PubMed  CAS  Google Scholar 

  22. Barsky AJ, Wyshak G, Klerman GL. Hypochondriacs, doctors, and medical care. 1991 (in press).

  23. Zinn WM. Doctors have feelings too. JAMA. 1988;259:3296–8.

    Article  PubMed  CAS  Google Scholar 

  24. Kleinman AM, Eisenberg L, Good B. Culture, illness and care. Ann Intern Med. 1978;88:251–8.

    PubMed  CAS  Google Scholar 

  25. Quill TE. Somatization disorder: one of medicine’s blind spots. JAMA. 1985;254:3075–9.

    Article  PubMed  CAS  Google Scholar 

  26. Katon W, Roy-Byrne PP. Antidepressants in the medically ill: diagnosis and treatment in primary care. Clin Chemistry. 1988;34:829–36.

    CAS  Google Scholar 

  27. Katon W. Panic disorder: epidemiology, diagnosis, and treatment in primary care. J Clin Psychiatry. 1986;47:21–7.

    PubMed  Google Scholar 

  28. Smith RG, Monson RA, Ray DC. Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med. 1986;314:1407–13.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported by grant MH41739-02 from the National Institute of Mental Health, Rockville, Maryland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lin, E.H.B., Katon, W., Von Korff, M. et al. Frustrating patients. J Gen Intern Med 6, 241–246 (1991). https://doi.org/10.1007/BF02598969

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02598969

Key words

Navigation