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Predictors of physician frustration in the care of patients with rheumatological complaints

  [ 77 votes ]   [ Discuss This Article ]
By Walker EA, Katon WJ, Keegan D, Gardner G, Sullivan M • • September 12, 1997

Recent studies of the doctor-patient relationship have shown
that certain patients are perceived as frustrating or
difficult by their doctors; however, little is known about the
characteristics of these patients that elicit this
dissatisfaction. As part of a larger study of rheumatology
clinic patients with fibromyalgia or rheumatoid arthritis (N =
68) we used stepwise multiple regression to select the factors
most associated with physician frustration while controlling
for the effects of other variables. Variable domains included
demographics, psychiatric diagnoses, personality factors,
functional disability, disease state, and trauma history.
These domains as well as individual variables within these
domains were systematically evaluated for their unique
contribution to the prediction of physician frustration as
measured by the Difficult Doctor-Patient Relationship
Questionnaire (DDPRQ). Initial bivariate correlates of
physician frustration included marital status, current
dysthymia and agoraphobia, lifetime panic disorder and
obsessive-compulsive disorder, adult rape and physical abuse,
somatization disorder, physical and social disability, the
presence of fibromyalgia, as well as neuroticism, illness
impact, and perceived loss of control. The best multivariable
model for estimating frustration magnitude included
somatization disorder, perception of lack of control over
illness, and a lifetime history of obsessive-compulsive
disorder. These factors explained 48% of the variance in DDPRQ
score. Physicians in this study were most frustrated with
patients who had ongoing preoccupation with multiple medically
unexplained physical symptoms as well as the perception of
greater impact and lack of control over their illness. These
findings suggest that treatment of somatization in patients
with chronic symptoms may decrease physician frustration.

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