Patients who frustrate physicians because of what the physicians consider excessive psychological dependence on the medical care system are more likely to be unmarried than married, according to a research team in Seattle.
Physicians often label such patients "crocks," "turkeys," "thick chart patients," or -- in England -- "heartsink" patients, because when the physician sees them on their schedules, their hearts sink. Now a team of psychiatrists at the University of Washington Medical Center is studying what kinds of patients evoke such strong reactions. One of the indicators they uncovered was marital status: unmarried patients were more likely to be frustrating than their married counterparts.
When Edward A, Walker, MD, and his colleagues examined 68 patients in a rheumatology clinic, they report in the September issue of General Hospital Psychiatry, they found that the best predictors of physician frustration were that the patient had multiple unexplainable physical symptoms (referred to as "somatization"), felt that he or she lacked control over the illness, and had a lifetime history of obsessive-compulsive disorder. Physician frustration also correlated with patient depression, panic states, adult rape and physical abuse.
The team examined the number and severity of patients' physical symptoms, their history of trauma, the extent of their physical impairment, sleep habits, the quality of pain, the patients' own assessment of their illness and the quality of their interactions with physicians. They then matched their findings to physician frustration as measured by a specially designed Difficult Doctor-Patient Relationship Questionnaire.
According to the authors of the study, greater appreciation by doctors of their patients' emotional reactions will improve communication, treatment and satisfaction.
In an accompanying editorial the journal's editor, Don R. Lipsitt, MD, cautions, "What is missing from the study...as in most studies of patient-doctor relationships, is an exploration of physician characteristics that may contribute to discordant interactions."
Lipsitt warns that if patients who consume too much of a doctor's time were a problem in the past, it will get much worse under managed care.
"Physicians are obligated (under managed care) to see more patients in less time and to treat rapidly and -- if possible -- briefly" Lipsitt writes. "...(I)f upwards of 70%-80% of primary care practice consists of patients with no detectable organic disease, how long will it take for physicians to be terminally frustrated and to 'burn out' and for patients to go uncared for?" an extreme but not implausible forecast....
"If our fast-food society also becomes a fast-care society, the process may ultimately squeeze out the essential ingredients of a workable patient-doctor relationship, leaving both frustrated doctors and frustrated patients."
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Dr. Lipsitt at (617) 499-5008.
To contact Dr. Walker, call (206) 543-3128
Posted by: Center for the Advancement of Health
Contact: Richard Hébert, (202) 387-2829; rhebert@cfah.org
Journal
General Hospital Psychiatry