Difficult patient–doctor encounters in a Swiss university outpatient clinic: cross-sectional study

Mota, Pau; Selby, Kevin; Gouveia, Alexandre; Tzartzas, Konstantinos; Staeger, Philippe; Marion-Veyron, Régis; Bodenmann, Patrick

doi:10.1136/bmjopen-2018-025569

Cited by 20 publications

(30 citation statements)

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“…During 2017, CGM GPs conducted more than 18′000 consultations and followed up 4′000 patients. About 40% of consulting patients have psychosocial vulnerabilities [19]. These particular features should be kept in mind in order to avoid overgeneralizing of our results.…”

Section: Methodsmentioning

confidence: 99%

General practitioners referring patients to specialists in tertiary healthcare: a qualitative study

et al. 2019

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BackgroundThere is a large and unexplained variation in referral rates to specialists by general practitioners, which calls for investigations regarding general practitioners’ perceptions and expectations during the referral process. Our objective was to describe the decision-making process underlying referral of patients to specialists by general practitioners working in a university outpatient primary care center.MethodsTwo focus groups were conducted among general practitioners (10 residents and 8 chief residents) working in the Center for Primary Care and Public Health (Unisanté) of the University of Lausanne, in Switzerland. Focus group data were analyzed with thematic content analysis. A feedback group of general practitioners validated the results.ResultsParticipating general practitioners distinguished two kinds of situations regarding referral: a) “clear-cut situations”, in which the decision to refer or not seems obvious and b) “complex cases”, in which they hesitate to refer or not. Regarding the “complex cases”, they reported various types of concerns: a) about the treatment, b) about the patient and the doctor-patient relationship and c) about themselves. General practitioners evoked numerous reasons for referring, including non-medical factors such as influencing patients’ emotions, earning specialists’ esteem or sharing responsibility. They also explained that they seek validation by colleagues and postpone referral so as to relieve some of the decision-related distress.ConclusionsGeneral practitioners’ referral of patients to specialists cannot be explained in biomedical terms only. It seems necessary to take into account the fact that referral is a sensitive topic for general practitioners, involving emotionally charged interactions and relationships with patients, colleagues, specialists and supervisors. The decision to refer or not is influenced by multiple contextual, personal and clinical factors that dynamically interact and shape the decision-making process.

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Section: Methodsmentioning

confidence: 99%

General practitioners referring patients to specialists in tertiary healthcare: a qualitative study

et al. 2019

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“…The percentage of DPEs in the university hospital in our study was 39.4%, which was significantly higher than that in the community hospitals. The frequency of DPEs in Swiss University Hospitals was reported to be 29.8% (23). To promote functional differentiation and coordination of outpatient care, a system has been introduced at university and other hospitals with specific functions whereby patients without a letter of referral are required to pay a special fee to visit physicians (24).…”

Section: Discussionmentioning

confidence: 99%

Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study

et al. 2023

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Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined firstvisit patients " 15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE " 31 points; non-DPE ! 30 points) and patient age, sex, and presence of psychological or social problems. ResultsThe valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.

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“…Previous research may be viewed as somewhat single-sided; this also seems to place the responsibility of the experienced “difficulty” on naturalistic factors originating from the patient himself. However, some recent explorations of “difficult” patients in dentistry emphasize the impact of complexity as a predictor of encounters perceived as difficult [ 13 , 16 ]. A study conducted in mental health care showed that perceived “difficulties” differed between different groups of patients, professional caregivers, and experts.…”

Section: Introductionmentioning

confidence: 99%

“…Taking recent studies into account [ 6 , 13 , 14 , 16 ], one may argue that the “difficult” dental patient is a triadic rendezvous between caregiver, patient, and the clinical context of care. Understanding what factors are perceived as “difficult”, can be of importance to assist our profession to make full use of the care available.…”

Section: Introductionmentioning

confidence: 99%

“…The "difficult" patient is a well-known character that appears in various health care settings, such as health care in medicine [1,2], mental health care [3][4][5][6][7], and dental health care [8,9]. In the arena of health care in medicine, at least 15-30% of patients are perceived as "difficult" in some respects [1,[10][11][12][13]. While the prevalence of "difficult" patients in dental health care is more uncertain, there is one study that indicates an estimated challenging patient rate of 25% [14].…”

Section: Introductionmentioning

confidence: 99%

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“Difficult” dental patients: a grounded theory study of dental staff’s experiences

et al. 2022

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Introduction The “difficult” patient is a well-known and potentially negative character in various care contexts. Objectives This study aimed to generate a conceptual framework explaining the main concerns about “difficult” dental patients, and obtain a deeper understanding of their characteristics, how they affect the dental staff and how the staff think and act in order to manage these patients. Methods Ten interviews were conducted with professional dental caregivers, including dentists, dental hygienists, and dental nurses. The audio-recorded interviews were transcribed and analyzed in accordance with the principles of grounded theory. Results The main concern regarding “difficult” dental patients generated a framework of seven descriptive interrelated lower-level categories grounded in the data, subsumed in the core category “balancing subjective difficulties”. The informants perceived the possession of “showing interaction difficulties” and “having bio-psycho-social complexity”, as characteristic features of “difficult” patients, who could further adversely affect the dental staff by “evoking negative emotions and behaviors”, “hampering self-esteem and job satisfaction”, and “impairing life and health in general”. To manage the dental care of these patients, the staff used strategies aimed at “activating internal and external resources” and “creating adaptive treatment relations” with patients. Conclusions The dental staff’s meaning of the phenomenon of “difficult” dental patients points to specific characteristics, effects, and handling strategies. The core category captures the contradictory dynamics of characteristics and affects as these concepts seem interrelated to the caregivers’ handling capacity. The dental staff’s possibility of handling the main concern through balancing subjective difficulties depends on contextual conditions regarding time, to bring the patient and/or oneself at the center of attention. This indicates a need for further research regarding dental interactions and studies generalizing the outlook on “difficult” dental patients.

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Difficult patient–doctor encounters in a Swiss university outpatient clinic: cross-sectional study

Cited by 20 publications

References 15 publications

General practitioners referring patients to specialists in tertiary healthcare: a qualitative study

General practitioners referring patients to specialists in tertiary healthcare: a qualitative study

Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study

“Difficult” dental patients: a grounded theory study of dental staff’s experiences

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