"Difficult patients" as family physicians perceive them.

The physician patient relationship is an important part of medical care. This study examined events that can jeopardize that relationship, i.e., patients' behaviors and attributes that physicians find frustrating. Data were collected from practicing family physicians (N-34) using a 32 item questionnaire developed by the author. Items were drawn from previous research on the behaviors of difficult patients and checked for relevance by two family physicians before the study began. Coefficient alpha was 92. Participants were predominantly male physicians who had been in practice for an average of 18 years. They were asked to indicate if they found specific patients' characteristics frustrating or annoying by using a 9 point scale with endpoints of "not at all frustrating or annoying" (1) and "very frustrating or annoying" (9). The physicians rated half of the listed patients' attributes as at least moderately frustrating (mean rating > 61. Over 80% of the physicians were frustrated by patients who expected to "cure," brought up new symptoms at the last moment, appeared to be malingering or refused to take responsibility for their health. They were least frustrated by disease related conditions such as degenerative or chronic illnesses. The physicians' ratings were unrelated to their years of experience. Results are discussed in relation to changing disease patterns which have occurred in this country over the last half century.