Difficult patient encounters in the ambulatory clinic: Clinical predictors and outcomes

Jeffrey L. Jackson, Kurt Kroenke

Research output: Contribution to journalArticle

221 Citations (Scopus)

Abstract

Background: One sixth of patient encounters are perceived as difficult by clinicians. Our goal was to assess clinical predictors and outcomes from such encounters. Methods: Five hundred adults presenting to a primary care walk-in clinic with a physical symptom completed surveys before the visit, immediately after the visit, at 2 weeks, and at 3 months. Patient measurements included mental disorders (PRIME-MD), functional status (Medical Outcomes Study Short-Form Health Survey [SF-6]), satisfaction (RAND 9-item survey), symptom resolution, visit costs, previsit and residual expectations of care, and health services utilization. Measurements from the 38 participating clinicians included the Physician's Belief Scale and physician perception of encounter difficulty (Difficult Doctor-Patient Relationship Questionnaire). Results: Seventy-four patient encounters (15%) were rated as difficult. Patients in such encounters were more likely to have a mental disorder (odds ratio, 2.4; 95% confidence interval, 1.3-4.4), more than 5 somatic symptoms (odds ratio, 1.4; 95% confidence interval, 1.1-1.8), and more severe symptoms (odds ratio, 1.6; 95% confidence interval, 1.04-2.3). Difficult-encounter patients had poorer functional status, more unmet expectations (P=.005), less satisfaction with care (P = .03), and higher use of health services (P<.001). Clinicians with poorer psychosocial attitudes as reflected by higher scores on the Physician's Belief Scale experienced more encounters as being difficult (23% vs 8%; P<.001). Conclusions: Patients presenting with physical symptoms who are perceived as difficult are more likely to have a depressive or anxiety disorder, poorer functional status, unmet expectations, reduced satisfaction, and greater use of health care services. Physicians with poorer psychosocial attitudes are more likely to experience encounters as difficult.

Original languageEnglish
Pages (from-to)1069-1075
Number of pages7
JournalArchives of Internal Medicine
Volume159
Issue number10
DOIs
StatePublished - May 24 1999

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Health Services
Physicians
Odds Ratio
Confidence Intervals
Mental Disorders
Depressive Disorder
Health Surveys
Anxiety Disorders
Primary Health Care
Outcome Assessment (Health Care)
Delivery of Health Care
Costs and Cost Analysis
Surveys and Questionnaires
Medically Unexplained Symptoms

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Difficult patient encounters in the ambulatory clinic : Clinical predictors and outcomes. / Jackson, Jeffrey L.; Kroenke, Kurt.

In: Archives of Internal Medicine, Vol. 159, No. 10, 24.05.1999, p. 1069-1075.

Research output: Contribution to journalArticle

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