The difficult patient

In the November 15 issue of American Family Physician is a review entitled Management of the Difficult Patient. It offers an insightful analysis of the problem and some useful suggestions for primary care physicians. I spent about 20 years as a traditional office based internist before becoming a hospitalist. The article has a ring of truth, many of its points reminding me of things I learned from that experience.

It categorizes difficulties in the doctor-patient relationship into the areas of system problems, patient problems, and physician problems. System problems in primary care are all too well known, driven largely by financial pressures which translate into time constraints. Patient problems may be due to psychopathology in the patients themselves, often in the form of a personality disorder. Finally if you, the physician, think all or most patients are “difficult” you may have issues of your own to face.