Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med 1999 May 24;159(10):1069-75
Date
05/21/1999Pubmed ID
10335683DOI
10.1001/archinte.159.10.1069Scopus ID
2-s2.0-0033599960 (requires institutional sign-in at Scopus site) 278 CitationsAbstract
BACKGROUND: One sixth of patient encounters are perceived as difficult by clinicians. Our goal was to assess clinical predictors and outcomes from such encounters.
METHODS: Five hundred adults presenting to a primary care walk-in clinic with a physical symptom completed surveys before the visit, immediately after the visit, at 2 weeks, and at 3 months. Patient measurements included mental disorders (PRIME-MD), functional status (Medical Outcomes Study Short-Form Health Survey [SF-6]), satisfaction (RAND 9-item survey), symptom resolution, visit costs, previsit and residual expectations of care, and health services utilization. Measurements from the 38 participating clinicians included the Physician's Belief Scale and physician perception of encounter difficulty (Difficult Doctor-Patient Relationship Questionnaire).
RESULTS: Seventy-four patient encounters (15%) were rated as difficult. Patients in such encounters were more likely to have a mental disorder (odds ratio, 2.4; 95% confidence interval, 1.3-4.4), more than 5 somatic symptoms (odds ratio, 1.4; 95% confidence interval, 1.1-1.8), and more severe symptoms (odds ratio, 1.6; 95% confidence interval, 1.04-2.3). Difficult-encounter patients had poorer functional status, more unmet expectations (P=.005), less satisfaction with care (P=.03), and higher use of health services (P<.001). Clinicians with poorer psychosocial attitudes as reflected by higher scores on the Physician's Belief Scale experienced more encounters as being difficult (23% vs 8%; P<.001).
CONCLUSIONS: Patients presenting with physical symptoms who are perceived as difficult are more likely to have a depressive or anxiety disorder, poorer functional status, unmet expectations, reduced satisfaction, and greater use of health care services. Physicians with poorer psychosocial attitudes are more likely to experience encounters as difficult.
Author List
Jackson JL, Kroenke KAuthor
Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAmbulatory Care
Attitude of Health Personnel
Female
Humans
Male
Mental Disorders
Middle Aged
Office Visits
Patient Satisfaction
Physician-Patient Relations
Predictive Value of Tests
Primary Health Care
Severity of Illness Index