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

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_B8ED9CC35C34
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Difficult patient-doctor encounters in a Swiss university outpatient clinic: cross-sectional study.
Journal
BMJ open
Author(s)
Mota P., Selby K., Gouveia A., Tzartzas K., Staeger P., Marion-Veyron R., Bodenmann P.
ISSN
2044-6055 (Electronic)
ISSN-L
2044-6055
Publication state
Published
Issued date
25/01/2019
Peer-reviewed
Oui
Volume
9
Number
1
Pages
e025569
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Previous research has shown that multiple factors contribute to healthcare providers perceiving encounters as difficult, and are related to both medical and non-medical demands.
To measure the prevalence and to identify predictors of encounters perceived as difficult by medical residents.
Cross-sectional study at the Department of Ambulatory Care and Community Medicine (DACCM), a university outpatient clinic with a long tradition of caring for vulnerable patients.
We identified difficult doctor-patient encounters using the validated Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10), and characterised patients using the patient's vulnerability grid, a validated questionnaire measuring five domains of vulnerability, both completed by medical residents after each encounter. We used a multiple linear regression model with the outcome variable as the DDPRQ-10 score, controlling for resident characteristics.
We analysed 527 patient encounters performed by all 27 DACCM residents (17 women and 10 men). We asked each medical resident to evaluate 20 consecutive consultations starting on the same date.
One hundred and fifty-seven encounters (29.8%) were perceived as difficult.
After adjusting for differences among residents, all five domains of the patient vulnerability grid were independently associated with a difficult encounter: frequent healthcare user; psychological comorbidity; health comorbidity; risky behaviours and a precarious social situation.
Nearly a third of encounters were perceived as difficult by medical residents in our university outpatient clinic that cares for a high proportion of vulnerable patients. This represents twice the average ratio of difficult encounters in general practice. All five domains of patient vulnerability appear to have partial explanatory power on medical residents' perception of difficult patient encounters.
Keywords
difficult doctor-patient encounter, general practice medicine, vulnerable patients
Pubmed
Web of science
Open Access
Yes
Create date
18/02/2019 10:53
Last modification date
12/11/2019 15:19
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