Dysfunctional Doctor-Patient Relationships and Their Effect on Illness

Abstract

It is well known in clinical practice…both medical and psychiatric…that certain patients evoke negative attitudes and affects, including rage and hate, in their physicians. Such responses lead to discordant and/or dysfunctional relationships which, it is observed, affect clinical course and outcome. Patients who arouse negative feelings in physicians may include individuals with particular physical diseases such as bronchial asthma, cancer, alcoholism, labile hypertension, obesity, and so on. More commonly, patients with obnoxious personality traits or troublesome illness behabior are labelled "problem patients, " "difficult patients, " "help-rejecting complainers, " "malingerers, " "hypochondriacs, " "illness addicts, " "hateful patients, " and so on, with each culture establishing its own list of pejorative terms. Such reactions often interfere with the physician's ability to adequately assess and, if indicated, to treat patients appropriately. Patients hastily labelled "hypochondriacs" or "factitious illness" are particularly at risk to have treatable pathology overlooked orprematurely dismissed. The field of psychosomatic medicine has recognized, through clinical and research data, both human and animal, that social interaction, communication, and object relationships have significant effects upon physiologic, psychologic, endocrinologic, neurologic, hematologic, and immunologic mechanisms in the disease process. Much is also known about the placebo response and its power to effect physical and emotional change. It remains for psychosomatic research to elucidate the psychophysiology of physician-patient relationships with their transference and countertransference which can help to explain how negative repressed attitudes and affects in the physician can adversely influence the patient's health and disease. This presentation will review this problem, summarize pertinent literature, and suggest potential avenues of exploration.