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

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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


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


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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