The presence of certain risk factors increase the risk that the encounter between a physician and patient may be perceived as difficult by the physician.

Independent Predictor

Odds Ratio

95% CI

depressive or anxiety disorder


(1.5 - 3.9)

>= 5 physical symptoms


(1.1 - 3.1)

severity of symptoms > 6 on a 10 point scale (with 10 unbearable)


(1.0 - 2.4)

poorer physician psychosocial attitude score


(1.6 - 9.5)



• The physician's psychosocial attitude is measured using the Physician Belief Scale.



• The greater the mismatch between a patient with active psychosocial problems and the physician with poor tolerance of psychosocial problems, the more likely that the encounter will be viewed as difficult by the physician.

• The patients of "difficult" encounters tend to have reduced satisfaction, more unmet expectations, and make greater use of health care services.

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