Burcu KAYHAN TETİK, Yusuf ÜSTÜ, Kamuran Bahar SANDIKCI, Derya IŞIK, Mert Muhittin SANDIKCI, Mehmet UĞURLU

Attitudes and behaviors of physicians in dealing with difficult patients and relatives: a cross-sectional study in two training and research hospitals

Background/aim: The aim of this study was to examine the reasons constituting the definition of difficult patient and to evaluate attitudes and behaviors of physicians in coping with these patients and their relatives. Materials and methods: This cross-sectional study was conducted in May and June 2013 with 400 randomly selected physicians from different specialties working in two training and research hospitals in Ankara. A questionnaire was created by reviewing the relevant literature, by family medicine clinic, and delivered to the physicians following a pilot study. Results: In our study 92.8% of the physicians participating had experienced a negative contact with patients and/or their relatives, previously; 46.8% of the participants stated that they used their own experiences in coping with those situations. The frequency of negative communications was higher in surgical departments, increasing with average daily working hours and number of patients and decreasing with the experience of the physicians. The ways of coping with a difficult patient were nonjudgmental listening, patience, tolerance, and empathy, in declining order of importance. Conclusion: Physicians frequently experience negative communications with patients and/or relatives. Awareness of physicians about the concept of difficult patients and the causes and solutions should be enhanced.

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1. Aspegren K. Teaching and learning communication skills in medicine - a review with quality grading of articles. Medical Teacher 1999; 21: 563-570.
2. Brown J. How clinical communication has become a core part of medical education in the UK. Med Educ 2008; 42: 271-278.
3. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995; 310: 1122- 1126.
4. Đorđević V, Bra M, Brajković L. Person-centered medical interview. Croat Med J 2012; 53: 310-313.
5. Ong LM, De Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Social Science & Medicine 1995; 40: 903-918.
6. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009; 47: 826-834.
7. Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ 2002; 325: 697.
8. Haas LJ, Leiser JP, Magill MK, Sanyer ON. Management of the difficult patient. Am Fam Physician 2005; 72: 2063-2068.
9. Kroenke K. Unburdening the difficult clinical encounter. Arch Intern Med 2009; 169: 333-334.
10. An PG, Rabatin JS, Manwell LB, Linzer M, Brown RL, Schwartz MD. Burden of difficult encounters in primary care: data from the minimizing error, maximizing outcomes study. Arch Intern Med 2009; 169: 410-414.
11. Lorenzetti RC, Jacques CM, Donovan C, Cottrell S, Buck J.. Managing difficult encounters: understanding physician, patient, and situational factors. Am Fam Physician 2013; 87: 419-425.
12. Dhar H, Dhar D. Difficult patient encounters in the developing world. Middle East Journal of Family Medicine 2013; 11: 41-47.
13. Magnus SA, Mick SS. Medical schools, affirmative action and the neglected role of social class. Am J Public Health 2000; 90: 1197-1201.
14. Krebs EE, Garrett JM, Konrad TR. The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC Health Serv Res 2006; 6: 128-135.
15. Elder N, Ricer R, Tobias B. How respected family physicians manage difficult patient encounters. J Am Board Fam Med 2006; 19: 533-541.
16. Mathers N, Jones N, Hannay D. Heartsink patients: a study of their general practitioners. Br J Gen Prac 1995; 45: 293-296.
17. An PG, Manwell LB, Williams ES, Laiteerapong N, Brown RL, Rabatin JS, Schwartz MD, Lally PJ, Linzer M. Does a higher frequency of difficult patient encounters lead to lower quality care? J Fam Pract 2013; 62: 24-29.
18. Ratanawongsa N, Roter D, Beach MC, Laird SL, Larson SM, Carson KA, Cooper LA. Physician burnout and patientphysician communication during primary care encounters. J Gen Intern Med 2008; 23: 1581-1588.
19. Çelik C, Yurdakul M. Problem solving skills of hospital managers: a field research. Journal of the Cukurova University Institute of Social Sciences 2009; 18: 95-108 (article in Turkish with an abstract in English).
20. Kravitz RL. Measuring patients expectations and requests. Ann Intern Med 2001; 134: 881-888.
21. Virshup BB, Oppenberg AA, Coleman MM. Strategic risk management: reducing malpractice claims through more effective patient-doctor communication. Am J Med Qual 1999; 14: 153-159.
22. Huntington B, Kuhn N. Communication gaffes: a root cause of malpractice claims. Bayl Univ Med Cent Proc 2003; 16: 157- 161.
23. Mayou R, Sharpe M. Patients whom doctors find difficult to help: an important and neglected problem. Psychosomatics 1995; 36: 323-325.
24. John C, Schwenk TL, Roi LD, Cohen M. Medical care and demographic characteristics of difficult patients. J FamPrac 1987; 24: 607-610.
25. Lynch DJ, Mc Grady AV, Nagel RW, Wahl EF. The patientphysician relationship and medical utilization. Prim Care Companion J Clin Psychiatry 2007; 9: 266.
26. Celik F. Communication in health institutions; a research on patient and medical staff. PhD, Selçuk University Institute of Social Sciences, Konya, Turkey, 2008 (in Turkish).
27. Atilla G, Oksay A, Erdem RA. Qualitative pre-study on the physician-patient communication. İstanbul University Faculty of Communication Journal 2012; 43: 23-37 (article in Turkish with an abstract in English).
28. Yağbasan M, Çakar FA. A field study to reveal language - and attitude based communicational problems in doctor - patient relationship. Selçuk University The Journal of the Institute of Social Sciences 2006; 15: 609-629 (article in Turkish with an abstract in English).
29. Erjem Y, Çağlayandereli M. Television and youth: the effects of national television serials on the role modelling behaviour of youngsters. Cumhuriyet Üniversitesi Edebiyat Fakültesi Sosyal Bilimler Dergisi 2006; 30: 15-30 (article in Turkish with an abstract in English).
30. Wehbe-Janek K, Song J, Shabahang M. An evaluation of the usefulness of the standardized patient methodology in the assessment of surgery residents communication skills. J. Surg Educ 2011; 68: 172-177.
31. Rahman A. Initial assessment of communication skills of intern doctors in history-taking. Medical Teacher 2000; 22: 184-188.
32. Bredart A, Bouleuc C, Dolbeault S. Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol 2005; 17: 351-354.
33. Kılıç B, Sayek İ. Undergraduate medical education report 2000. Community and Physician 2001; 16: 230-240 (in Turkish).
34. Elçin M, Orhan Odabaşı O, Turan S, Sincan M, Başusta NB. Developing communication skills using standardized patients and structured assessments in medical education. Hacettepe Tıp Dergisi 2010; 41: 219-230 (article in Turkish with an abstract in English).
35. Şenol Y, Özdoğan M, Oktay C, Yılmaz TT, Bozcuk H. Doctor - Patient Relationship, - Communication skills training and role modelling of faculty member. Tıp Eğitimi Dünyası 2011; 31: 38-44 (article in Turkish with an abstract in English).
36. Harvey KJ, Vitry AI,Roughead E, Aroni R, Balenden N, Faggotter R. Pharmaceutical advertisement in prescribing software: an analysis. Med J Aust 2005; 183: 75-79.
37. Tanrıverdi H, Teker ÇA. Comparison of performance measures in education hospitals in point of clinical work loads in assistant doctors. Sağlıkta Performans ve Kalite Dergisi 2010; 1: 114 (article in Turkish with an abstract in English).
38. Hinchey SA, Jackson JL. A cohort study assessing difficult patient encounters in a walk-in primary care clinic, predictors and outcomes. J Gen Intern Med 2011; 26: 588-594.
39. Serour M, Othman HA, Khalifah GA. Difficult patients or difficult doctors: an analysis of problematic consultations. European Journal of General Medicine 2009; 6: 87-93.
40. Tan MN, Özçakar N, Kartal M. Resident doctors professional satisfaction and its effect on their lives. Marmara Medical Journal 2012; 25: 20-25 (article in Turkish with an abstract in English).
41. Adıgüzel Z. The characteristics of the communication between the health personnel- patients and elements influencing communications (Celal Bayar University Health Practice and Study Center). PhD, Celal Bayar University Institute of Social Sciences, Manisa, 2005 (in Turkish).
42. Breuner CC, Moreno MA. Approaches to the difficult patient/ parent encounter. Pediatrics 2011; 27: 163-169.
43. Çobanoğlu N. Kuramsal ve Uygulamalı Tıp Etiği. 1st ed. Ankara, Turkey: Eflatun Printing House; 2009 (in Turkish).
44. Hahn SR, Kroenke K, Spitzer RL, Brody D, Williams JB, Linzer M. The difficult patient. J Gen Intern Med 1996; 11: 1-8.
45. Akgün Çitak E, Avci S, Basmaci Ö, Durukan İ. Investigating the communication behaviours of nurses towards patients defined as difficult by nurses in a university hospital. Turkish Journal of Research & Development in Nursing 2011; 13: 35-46 (article in Turkish with an abstract in English).
46. Steinmetz D, Tabenkin H. The difficult patient as perceived by family physicians. Family Practice 2001; 18: 495-500.
47. Romano SE, Schwenk TL. The challenging patient encounter. In: Sloane PD, Slatt LM, Ebell MH, Jacques LB, Smith MA, editors. Essentials of Family Medicine. 5th ed. Philadelphia, PA, USA: Lippincott Williams & Williams; 2008. pp. 31-38.
48. Kutlu M, Çolakoğlu N, Özgüvenç ZP. A study on the importance of empathy in patient-doctor relationship. Sağlıkta Performans ve Kalite Dergisi 2010; 1: 127-143 (article in Turkish with an abstract in English).