Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Nov 24:10:96.
doi: 10.1186/1471-244X-10-96.

Ambivalent connections: a qualitative study of the care experiences of non-psychotic chronic patients who are perceived as 'difficult' by professionals

Bauke Koekkoek  1 , Berno van Meijel, Joyce van Ommen, Renske Pennings, Ad Kaasenbrood, Giel Hutschemaekers, Aart Schene
Affiliations
Comparative Study

Ambivalent connections: a qualitative study of the care experiences of non-psychotic chronic patients who are perceived as 'difficult' by professionals

Bauke Koekkoek et al. BMC Psychiatry. .

Abstract

Background: Little is known about the perspectives of psychiatric patients who are perceived as 'difficult' by clinicians. The aim of this paper is to improve understanding of the connections between patients and professionals from patients' point of view.

Methods: A Grounded Theory study using interviews with 21 patients from 12 outpatient departments of three mental health care facilities.

Results: Patients reported on their own difficult behaviours and their difficulties with clinicians and services. Explanations varied but could be summarized as a perceived lack of recognition. Recognition referred to being seen as a patient and a person - not just as completely 'ill' or as completely 'healthy'. Also, we found that patients and professionals have very different expectations of one another, which may culminate in a difficult or ambivalent connection. In order to explicate patient's expectations, the patient-clinician contact was described by a stage model that differentiates between three stages of contact development, and three stages of substantial treatment. According to patients, in each stage there is a therapeutic window of optimal clinician behaviour and two wider spaces below and above that may be qualified as 'toxic' behaviour. Possible changes in clinicians' responses to 'difficult' patients were described using this model.

Conclusions: The incongruence of patients' and professionals' expectations may result in power struggles that may make professionals perceive patients as 'difficult'. Explication of mutual expectations may be useful in such cases. The presented model gives some directions to clinicians how to do this.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Stages of contact, interventions, and respective therapeutic windows.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298:883–997. doi: 10.1056/NEJM197804202981605. - DOI - PubMed
    1. Lin EH, Katon W, Korff Von, Bush P, Lipscomb P, Russo J. et al.Frustrating patients: physician and patient perspectives among distressed high users of medical services. J Gen Intern Med. 1991;6:24124–6. - PubMed
    1. Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med. 1999;159:1069–1075. doi: 10.1001/archinte.159.10.1069. - DOI - PubMed
    1. Hahn SR, Kroenke K, Spitzer RL, Brody D, Williams JBW, Linzer M, Verloin deGruy F. The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med. 1996;11:1–8. doi: 10.1007/BF02603477. - DOI - PubMed
    1. Steinmetz D, Tabenkin H. The 'difficult patient' as perceived by family physicians. Fam Pract. 2001;18:495–500. doi: 10.1093/fampra/18.5.495. - DOI - PubMed

Publication types