Objective:
To identify differences between patients viewed as frustrating by their physicians and those considered typical and satisfying.
Design:This cross-sectional observational study focused on psychologically distressed high users of medical services. Frustrating
patients were compared with typical and satisfying patients, using data from patient questionnaires, physician assessments,
structured psychiatric interviews, and computerized utilization records.
Setting:Group Health Cooperative of Puget Sound, a large health maintenance organization.
Patients/participants:Study patients were in the top decile for ambulatory visits, and had elevated scores for anxiety, depression, and somatization.
Among the 339 patients invited to participate in the study, 251 agreed, and 228 were rated by their physicians.
Main results:A substantial proportion (37%) of the high users were viewed as frustrating by their physicians. Physicians’ ratings of physical
disease severity did not differ among the groups, but frustrating patients rated their own health status less favorably and
reported more somatic symptoms and disabilities. The frustrating group utilized more medical services than did other distressed
high utilizers. All three groups had a high prevalence of mental disorders. However, frustrating patients had higher rates
of somatization and generalized anxiety disorder.
Conclusions:Physicians and their frustrating patients had contrasting views of the patients’ illnesses. The best predictors of physician
frustration were somatization and increased medical service utilization. There is need for further research and clinical attention
concerning optimal clinical management for patients with somatization.
Key words frustrating patients - somatization - medical services utilization
Supported by grant MH41739-02 from the National Institute of Mental Health, Rockville, Maryland.