• 作者：Xavier Mas Garriga^a ; ^{22716xmg@comb.es} ; Montserrat Navarro Gilo^a ; Judit Vá ; zquez Morocho^a ; Cristina Delso Gafarot^a ; Tarek Mahfouz Castejó ; n^a ; Jesú ; s Almeda Ortega^b
• 关键词：Relació ; n clí ; nica ; Relació ; n mé ; dico-paciente ; Encuentro difí ; cil ; Dificultad en la relació ; n mé ; dico-paciente ; Atenció ; n primaria
• 刊名：Atenci贸n Primaria
• 出版年：2009
• 期刊代码：pca69_02126567
• 类别：med
• 出版时间：January 2009
• 卷：41
• 期：1
• 页码：9-15
• 文件大小：454 K

Objectives

To find out the prevalence and causes of 鈥渄ifficult encounters鈥?(DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed.

Design

Cross-sectional, descriptive.

Setting

Urban health centre.

Participants and method

Four doctors, their 4 residents and patients who went to their clinics (March鈥揗ay 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire. Variables: sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a 鈥渄ifficult professional鈥?(DP) by the patient.

Results

There were 415 visits; 352 questionnaires (85%participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5%according to doctors (95%CI, 5.8鈥?1.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1%according to the patients (95%CI, 1.6鈥?.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81%of cases. CDE insignificant (魏=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95%CI, 3.1鈥?); 53 (15.1%) had changed at some point for this reason (95%CI, 11.3鈥?8.8) and 11 (3.1%) considered their doctor to be DP (95%CI, 1.6鈥?.5).

Conclusions

The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP.