Dependency, Psychpathology, and Difficult Doctor-Patient Relationships in Primary Care Patients

Abstract

Strong doctor-patient relationships and working alliance has much to do with the outcomes of healthcare. Strong relationships between physicians and patients can increase the treatment effectiveness and result in better outcomes. Dissatisfying relationships between doctors and their patients can have significant negative consequences. Difficult patients are higher utilizers of health care services, dissatisfied with the care that they receive, contribute to physician burnout and dissatisfaction, and overall have poorer treatment outcomes. Dependency is also related to patients' health with dependent and detached individuals being more likely to have mild short-term illnesses, have more serious illnesses, and be higher utilizers of health care. Adult patients (N =101) in a residency training family medicine clinic provided ratings of Destructive Overdependence, Dysfunctional Detachment, Healthy Dependency, Depression, Anxiety, and ratings of their experience. Their providers (N= 18) completed ratings of the patients' overall health as well as ratings of their experience with the patient (DDPRQ-10). Correlations were computed for Destructive Overdependence, Dysfunctional Detachment, Healthy Dependency, Depression, Anxiety, Overall health Status, and number of years of practice the physician has with both physicians' ratings of difficulty (DDPRQ-10) and the patients' ratings of difficulty (PDRQ). DDPRQ-10 ratings were significantly related to Dysfunctional detachment (r= .26), Depression (r .23) and overall health status ( r = -.42), A standard regression model run with all independent variables entered into the equation was significant in predicting DDPRQ-10 scores (R2= .322, F (3,97) = 6.313, p<.001). Dysfunctional Detachment, Destructive Overdependence, Depression, and the Overall Health Status of the patient all emerged as significant predictors. The PDRQ was only significantly correlated with the number of years of practice ( r= .21). The standard regression model in predicting PDRQ scores was not significant ((R2= .060, F (3,97) = .846, p>.05). In an exploratory path analysis age was entered into the model and emerged as a partial mediator through its relationship with the patient's overall health (B = -.22, &#946; = -3.51, p< .001), the number of years of practice the physician has (B = 3.06, &#946; = 2.40, p< .05), and the ratings of difficulty provided by the physician (B = -.12, &#946; = -3.65, p< .001).