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Misunderstandings and miscommunication are hallmarks of a problematic doctor-patient relationship

The outpatient setting provides an opportunity for residents to develop long-term mutually satisfying relationships with their patients. However, misunderstandings and miscommunication can lead to feelings of frustration and anxiety in the patient, physician, or both parties. A recent study examined the characteristics of a problematic doctor-patient relationship from the perspective of the patient and found that patients are more likely to have problematic relationships with residents whom they see as less available or less capable of handling medical complaints.

The study was conducted by Cornell University researchers Carla Boutin-Foster, M.D., M.S., and Mary E. Charlson, M.D., and supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00066). Their objective was to identify the characteristics of a problematic doctor-patient relationship from the perspective of primary care patients who were cared for by medical residents for an average of 1.6 years (an average of five visits). Prior studies have focused mainly on the perspective of the physician.

The researchers administered questionnaires about several aspects of the doctor-patient relationship to 151 patients whose primary care physicians were senior internal medicine residents. Among patients in relationships described as satisfying by their resident (half of all patients), 10 percent viewed the relationship as problematic. Of the other half of the patients involved in relationships described as problematic by their resident, 23 percent also viewed their relationship as problematic. Compared with residents in satisfactory relationships, those involved in relationships rated as problematic were more likely to be rated poor in availability (72 vs. 28 percent) and their ability to handle patients' medical complaints (56 vs. 44 percent).

There was no association between the demographic characteristics of the physician and the patient's perception of the relationship. However, patients who rated the relationship as problematic were much more likely to also report low social support (for example, from family or friends) compared with patients involved in relationships described as satisfying (76 vs. 16 percent). Recognizing that patients may be equally frustrated with the care they are receiving may prompt physicians to more closely examine their own role in the relationship.

See "Problematic resident-patient relationships," by Drs. Boutin-Foster and Charlson, in the November 2001 Journal of General Internal Medicine 16, pp. 750-754.

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