Physical symptoms and physician-experienced difficulty in the physician-patient relationship
Physical symptoms and physician-experienced difficulty in the physician-patient relationship
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DOI：
10.7326/0003-4819-134-9_part_2-200105011-00014
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发表时间：
2001-05-01
影响因子：
39.2
通讯作者：
Hahn, SR
中科院分区：
文献类型：
--
作者：
Hahn, SR
工作背景：医学实践有许多预期和公认的挑战，但所有医生都经历过一些病人的困难程度超出了这些预期。医生经历的困难与具有三种特征的综合征相关：患者精神病理学、粗暴的人际交往方式和多种身体症状。目的：评估身体症状数量和特定症状在确定是否发生医生经历的困难中所发挥的作用。设计：精神障碍初级保健评估流行病学调查数据的新分析（PRIME-MD）1000研究。设置：四个初级保健诊所。参与者：627名门诊患者，由27名医生就诊。测量：医生经历的困难是通过使用10项困难的医生患者关系问卷来测量的（DDPRQ-10）;使用PRIME-MD评估患者报告的身体症状和医生评估的精神病理学和躯体形式症状;使用医生问卷测量身体疾病。躯体症状数和躯体形式症状数与难度相关（r = 0.39和r = 0.37; P < 0.001），调整躯体和精神障碍后，两者的相关性仍显著（r = 0.20; P < 0.001）。难治患者更有可能出现16种身体症状中的每一种;即使在调整了身体和精神障碍之后，出现5种特定症状（胃痛、昏厥、稀便/腹泻、心悸和睡眠问题）中的1种的患者出现难治的几率也更大。DDPRQ-10上的所有10个项目都受到身体症状的影响，特别是那些询问医生挫折感和患者是否操纵和耗时的项目。身体症状和困难之间的联系部分是由于身体症状和精神障碍之间的联系，但症状也独立地导致困难，独立的组成部分，糖尿病相关的困难可能是由于1）患者和医生之间的差异，对治疗的期望和2）症状的一部分，赋予病人的“生病的角色”。
Background: The practice of medicine has many expected and accepted challenges, but all physicians experience some patients as difficult to a degree that transcends these expectations. Physician-experienced difficulty is associated with a syndrome of three characteristics: patient psychopathology, abrasive interpersonal styles, and multiple physical symptoms.Objective: To assess the roles played by the number of physical symptoms and by specific symptoms in determining whether physician-experienced difficulty occurs.Design: New analyses of epidemiologic survey data from the Primary Care Evaluation of Mental Disorders (PRIME-MD) 1000 Study.Setting: Four primary care clinics.Participants: 627 ambulatory patients seen by 27 physicians.Measurements: Physician-experienced difficulty was measured by using the 10-item Difficult Doctor Patient Relationship Questionnaire (DDPRQ-10); patient-reported physical symptoms and physician-assessed psychopathology and somatoform symptoms were evaluated by using the PRIME-MD; and physical illnesses were measured by using a physician questionnaire.Results: The number of physical symptoms and the number of somatoform symptoms correlated with difficulty (r = 0.39 and r = 0.37, respectively; P < 0.001), and the correlations remained significant after adjustment for physical and mental disorders (r = 0.20 for both correlations; P < 0.001). Difficult patients were more likely to have each of 16 physical symptoms; the odds of being difficult were greater for patients with 1 of 5 particular symptoms (stomach pain, fainting, loose stools/diarrhea, palpitations, and sleep problems), even after adjustment for physical and mental disorders. All 10 items on the DDPRQ-10 were influenced by physical symptoms, particularly those items that asked about physician frustration and whether patients were manipulative and time consuming.Conclusions: The association between physical symptoms and difficulty is due in part to the association between physical symptoms and mental disorders, but symptoms also contribute independently to difficulty, The independent component of symptom-associated difficulty may be due to 1) differences between patient and physician in expectations about treatment and 2) the part that symptoms play in conferring the "sick role" on a patient.