Physician Reactions to Difficult Patients

Although DSM-IV-TR is a useful aid for making a diagnosis, family physicians often recognize a patient with a personality trait or unexplained physical complaint by their own reaction to the patient. Physicians working with difficult patients seem to have specific and characteristic reactions to these patients that need to be recognized, understood, and used for the patient's benefit. Patient-generated feelings provoked in the physician are created through the interpersonal interaction between patient and physician. These reactions to a patient should alert the physician to a possible diagnosis of a difficult patient. Typical physician reactions to patients that are provoked by the patient are also called patient-generated countertransferences. These include intense feelings, uncharacteristic fantasies, or atypical behaviors by the physician.

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