Characteristics of Difficult Patients in Prisons Compared to Difficult Patients in Primary Care Settings

Research has found that patients perceived as being difficult by their physicians share a number of characteristics. These "difficult" characteristics include Axis I disorders, personality disorders, somatization, complex health problems, and aggression. Current research has focused on defining "difficult patients" in community populations, while other populations have gone overlooked. One population that has prevalence rates of the "difficult" characteristics identified in community samples is offenders. As a group, offenders tend to have high rates of mental illness, chronic health problems, and behavioral issues such as aggression. While difficult patients in prison may resemble difficult patients in the community, research has not examined patient characteristics among offenders. It may be that offenders present with additional "difficult" characteristics, such as malingering, due to the uniqueness of the prison environment. This study examined nurses perceptions to difficult patients in prison and in primary care settings. It was hypothesized that difficult offender patients would be perceived as having more psychopathology, malingering more frequently, seeking medication more frequently, making more frequent requests to see the doctor, and that there would be a higher rate of difficult patients in correctional settings as compared to difficult patients in primary care settings. Results show that correctional nurses perceived difficult patients exaggerating their medical symptoms more, being less truthful about their symptoms, being more drug-seeking, and being less reasonable in their requests for medication than difficult patients in the community. There were no significant results in ratings of mental health, manipulative behavior, or requests to see the physician. Additionally, correctional nurses indicated that there are a higher percentage of difficult patients in their setting as compared to community nurses. Results from this study will help generate techniques or suggestions that may alleviate some of the problems nurses experience while treating offenders as well as improving the overall quality of the interaction between offenders and health professionals. This may, in turn, improve offender patient medication compliance, reduce the number of unnecessary doctor appointments, and reduce health-care provider burn-out. Other possible implications include improving the overall health of offender patients and reducing the amount of unnecessary spending to treat patients (e.g.improving patient compliance).Emily S. KistlerSchriver, JenniferPatrick BennettThomas JohnsonDoctor of PsychologyDepartment of PsychologyCunningham Memorial library, Terre Haute, Indiana State University20110719-009DoctoralTitle from document title page. Document formatted into pages: contains 114p.: ill. Includes abstract and appendix