{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T09:51:07Z","timestamp":1777715467985,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T00:00:00Z","timestamp":1627776000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Psychiatry Med"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>All physicians experience some patients described as \u201cdifficult.\u201d Their prevalence negatively impacts work satisfaction. Prior research identified factors present when physicians perceive patients as difficult. Numerous variables are unrelated to vexing patient visits. Three additive patient characteristics predict difficult encounters: 1) depressive or anxiety comorbidity, 2) polysymptomatic patients, and 3) high symptom severity. The sole physician variable was their score on the Physician Belief Scale (PBS) which quantifies negative attitudes towards psychosocial problems. When all three patient predictors exist, high PBS scorers judge twice as many patients as difficult. Five clinic milieu variables correlated weakly with clinic satisfaction among primary care residents. They are: 1) minimal role conflict, 2) autonomy, 3) collegiality, 4) encouragement of professional growth, and 5) work group loyalty. \u201cPositive affect\u201d was among the strongest physician variables but the author labeled it a confounding variable. Finally, a small \u201cn\u201d QI study conducted in this author\u2019s residency explored the role of physician affectivity and identified additional physician characteristics and clinic milieu factors correlating with overall enjoyment of ambulatory clinic practice. Surprisingly, none of the five previously identified clinic milieu variables correlated directly with resident clinic satisfaction. \u201cSupportive staff cohesion\u201d was one milieu variable that correlated significantly with clinic satisfaction. Resident affective characteristics that significantly reduced clinic satisfaction were \u201chostility\u201d and \u201cnegative affectivity.\u201d \u201cJoviality\u201d was positively related to clinic satisfaction. While patient variables are uncontrollable, it is plausible that by physicians changing their beliefs and affectivity the percentage of vexing visits could be cut in half improving work satisfaction.<\/jats:p>","DOI":"10.1177\/00912174211032037","type":"journal-article","created":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T01:43:06Z","timestamp":1627868586000},"page":"354-363","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Vexing visits: Variables correlating with physician perceptions of patients as \u201cdifficult\u201d and overall enjoyment of their delivery of primary ambulatory care"],"prefix":"10.1177","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2017-9397","authenticated-orcid":false,"given":"Timothy Eugene","family":"Spruill","sequence":"first","affiliation":[{"name":"Department of Graduate Medical Education, AdventHealth East Orlando, AdventHealth East Orlando, Orlando, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,8,1]]},"reference":[{"key":"bibr1-00912174211032037","first-page":"933","volume":"11","author":"Crutcher JE","year":"1980","journal-title":"J Fam Pract"},{"key":"bibr2-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1007\/BF02603477"},{"key":"bibr3-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.10.1069"},{"key":"bibr4-00912174211032037","first-page":"291","volume-title":"Measuring functioning and well-being: the medical outcomes study approach","author":"Ware JE","year":"1992"},{"key":"bibr5-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520220043029"},{"key":"bibr6-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03510070057036"},{"key":"bibr7-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(84)90376-9"},{"key":"bibr8-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)90212-7"},{"key":"bibr9-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1177\/001872679304600806"},{"key":"bibr10-00912174211032037","first-page":"730","volume":"29","author":"Randall CS","year":"1997","journal-title":"Fam Med"},{"key":"bibr11-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.98.2.219"},{"key":"bibr12-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.54.6.1063"},{"key":"bibr13-00912174211032037","unstructured":"Freud S.\n                      Jokes and their relation to the unconscious.\n                      The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press, 1905, vol. 8, pp.1\u2013247."},{"key":"bibr14-00912174211032037","volume-title":"The how of happiness: a scientific approach to getting the life you want","author":"Lyubomirsky S.","year":"2008"},{"key":"bibr15-00912174211032037","volume-title":"The happiness advantage: the seven principles of positive psychology that fuel success and performance at work","author":"Achor S.","year":"2011"},{"key":"bibr16-00912174211032037","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.23.2880"}],"container-title":["The International Journal of Psychiatry in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00912174211032037","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00912174211032037","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00912174211032037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:15:15Z","timestamp":1777457715000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00912174211032037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,1]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1177\/00912174211032037"],"URL":"https:\/\/doi.org\/10.1177\/00912174211032037","relation":{},"ISSN":["0091-2174","1541-3527"],"issn-type":[{"value":"0091-2174","type":"print"},{"value":"1541-3527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,1]]}}}