Conclusion

Difficult patients contribute significantly to physician dissatisfaction with medical practice. The result is often poor quality of medical care for this difficult but all too common patient population. Special diagnostic, management, and intervention strategies exist for working with patients who have personality disorders or somatic complaints in the family medicine setting. The schema combines DSM-IV-TR diagnosis and cognitive-behavioral and psychodynamic viewpoints involving the patient's core beliefs and irrational thoughts, fears, defenses and coping style, behaviors, adherence to medical treatment, and use of medical services. Common physician reactions, general strategies, and specific physician interventions are also addressed, to maintain a working physician-patient relationship that permits the delivery of needed medical care.

www.guideline.gov/search/search.aspx?term=personality+disorders National Guideline Clearinghouse

Practice guidelines for borderline and antisocial personality disorders www.nlm.nih.gov

National Institute of Mental Health on Somatization and Personality Disorders www.psych.org

American Psychiatric Association

Information on somatic and personality disorders

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