Difficult encounters with psychiatric patients: A South Texas Psychiatry Practice-based Research Network (PBRN) study

Randall V. Sellers, Ricardo Salazar, Cervando Martinez, Stephen D. Gelfond, Melissa Deuter, Holly G. Hayes, Norma Ketchum, Brad H. Pollock

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Purpose: To examine the prevalence of difficult psychiatrist-patient interactions of 20 psychiatrists in the South Texas Psychiatric practice-based research network, determine what characteristics were associated with "difficult" patients, and compare findings with previous studies in primary care. Methods: During a 2-month observational study, psychiatrists collected patient information on setting, demographics, diagnoses, and medications and rated the patients using the Difficult Doctor-Patient Relationship Questionnaire, which had previously been used and validated in the primary care setting. Results: A total of 905 valid data cards were collected. Difficult patients were identified in 15% of the sample. Diagnoses of schizophrenia, alcohol/substance abuse, and personality disorder were associated with difficulty. Psychiatrists least burdened by difficult patients were older and in a solo practice and worked 51 to 55 hours per week. Conclusions: This cross-sectional study demonstrates that psychiatrists encounter difficult patients at a rate (15%) similar to that of primary care physicians. Mentoring programs and structured treatment interventions for the most difficult patient groups may assist all physicians who treat psychiatric patients, whether in specialty, family medicine, or other primary care settings.

Original languageEnglish (US)
Pages (from-to)669-675
Number of pages7
JournalJournal of the American Board of Family Medicine
Issue number5
StatePublished - Sep 2012


  • Doctor-patient relations
  • Mental health
  • Practice-based research
  • Practice-based research networks
  • Psychiatry
  • Quantitative research

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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