S Schafer1, D P Nowlis. 1. Department of Family Practice, University of California at San Francisco/Fresno Medical Education Program, USA.
Abstract
OBJECTIVE: To determine the association between "difficult" patient status and personality disorder. DESIGN: A survey using the Diagnostic Interview for Personality Disorders. PARTICIPANTS: Twenty-one patients nominated by 9 family medicine providers who subjectively experienced their care as difficult and 22 control subjects systematically selected from the same practices. MAIN OUTCOME MEASURE: The presence of personality disorder measured by the Diagnostic Interview for Personality Disorders. RESULTS: Personality disorders were more prevalent among the difficult patients: 7 of 21 difficult patients and 1 of 22 control subjects had at least 1 personality disorder (P = .02). Five of 7 difficult patients had dependent personality disorder. None of the providers realized that the difficult patients had personality disorders. CONCLUSIONS: Unrecognized personality disorder can make difficult provider-patient relationships more likely. Dependent personality disorder may be especially difficult. Improved physician awareness of personality disorders may lead to more effective understanding and treatment of some difficult patients.
OBJECTIVE: To determine the association between "difficult" patient status and personality disorder. DESIGN: A survey using the Diagnostic Interview for Personality Disorders. PARTICIPANTS: Twenty-one patients nominated by 9 family medicine providers who subjectively experienced their care as difficult and 22 control subjects systematically selected from the same practices. MAIN OUTCOME MEASURE: The presence of personality disorder measured by the Diagnostic Interview for Personality Disorders. RESULTS:Personality disorders were more prevalent among the difficult patients: 7 of 21 difficult patients and 1 of 22 control subjects had at least 1 personality disorder (P = .02). Five of 7 difficult patients had dependent personality disorder. None of the providers realized that the difficult patients had personality disorders. CONCLUSIONS: Unrecognized personality disorder can make difficult provider-patient relationships more likely. Dependent personality disorder may be especially difficult. Improved physician awareness of personality disorders may lead to more effective understanding and treatment of some difficult patients.
Authors: Joshua J Fenton; Peter Franks; Mitchell D Feldman; Anthony Jerant; Stephen G Henry; Debora A Paterniti; Richard L Kravitz Journal: J Gen Intern Med Date: 2014-11-06 Impact factor: 5.128