Patient Behaviors Adherence and Use of Medical Services

Difficult patients often display characteristic behaviors that affect their adherence to medical recommendations and use of medical services. Understanding these behaviors can also help physicians manage their expectations of these difficult patients and improve the chances for effective interventions that might improve medical adherence and health outcomes. In general, patients with cluster A personality disorders (paranoid, schizoid, and schizotypal) tend not to adhere to medical recommendations and underuse medical services. They may require outreach to involve them in their own medical care. Cluster B patients (antisocial, histrionic, borderline, narcissistic, and self-defeating) tend to have variable adherence to medical recommendations and may misuse, overuse, or underuse medical care. Cluster C patients (dependent, obsessive-compulsive, avoidant) tend to adhere to medical recommendations because of fear of the consequences of nonadherence. They are ambivalent users of the medical system and tend to use medical services appropriately when others are involved in their care.

Patients with somatic symptoms tend to overuse medical services and are reluctant to adhere to medical recommendations, even while seeking care from several providers. Somatic patients usually seek relief of physical symptoms through medical, not psychological, interventions. Patients with hypochondriasis or body dysmorphic disorder often initially avoid physicians out of fear or shame that they will be viewed as "crazy." Once they become patients, however, somatic patients also tend to pressure physicians to order many diagnostic tests and perform multiple procedures. They also tend not to adhere to medical recommendations.

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