THE DIFFICULT DOCTOR-PATIENT-RELATIONSHIP - SOMATIZATION, PERSONALITY AND PSYCHOPATHOLOGY

被引:196
作者
HAHN, SR
THOMPSON, KS
WILLS, TA
STERN, V
BUDNER, NS
机构
[1] ALBERT EINSTEIN COLL MED,DEPT MED,NEW YORK,NY
[2] ALBERT EINSTEIN COLL MED,DEPT PSYCHIAT,NEW YORK,NY
[3] UNIV PITTSBURGH,SCH MED,DEPT PSYCHIAT,PITTSBURGH,PA 15213
[4] ALBERT EINSTEIN COLL MED,DEPT EPIDEMIOL & SOCIAL MED,NEW YORK,NY
[5] FERKAUF GRAD SCH PSYCHOL,BRONX,NY 10461
[6] ALBERT EINSTEIN COLL MED,HLTH PSYCHOL PROGRAM,NEW YORK,NY
关键词
PHYSICIAN-PATIENT RELATIONSHIP; DIFFICULT PATIENTS; PSYCHOPATHOLOGY; PERSONALITY DISORDER; SOMATIZATION; PSYCHOMETRICS;
D O I
10.1016/0895-4356(94)90212-7
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
The difficult doctor-patient relationship and ''difficult patients'' have been the subject of considerable anecdotal study. Reliable methods for identification of difficult patients have not been available for the empirical study of their prevalence and characteristics. We developed the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ), composed of 30 Likert items, completed by physicians after encounters with patients. Adult patients and their providers in an academic, municipal hospital clinic participated in the instrument development (n = 92), reliability (n = 224), and assessment of patient characteristics phases (n = 113) of the study. The DDPRQ was shown to be a reliable, practical instrument. Factor analysis revealed 5 dimensions with face validity. The DDPRQ classified 10.3-20.6% of patient encounters as ''difficult'' depending on the sample. Demographic characteristics, provider characteristics and most medical diagnoses were not associated with DDPRQ score. In contrast, difficult patients were characterized by psychosomatic symptoms, at least mild personality disorder, and Axis I (major) psychopathology, and most had more than one of these characteristics. The need to identify and understand these components of difficult patient behavior and to include the doctor-patient relationship in strategies for managing the difficult patient is discussed.
引用
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页码:647 / 657
页数:11
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