Challenges in primary care relationships: seeing it from both sides.

Objective: This qualitative study explored perspectives of primary care providers and patients in challenging relationships.

Methods: In 2007, we conducted semi-structured interviews with providers recruited from 12 clinics affiliated with a U.S. academic center. Providers identified patients with whom they had ongoing "challenging relationships," and we interviewed the first consenting patient for each provider. We compared numeric ratings of relationship quality statistically. Using an editing analysis style, ≥2 investigators coded transcripts to identify themes.

Results: Seventeen dyads participated. Providers averaged 14 years in practice. Most were Caucasian (88%) and female (59%). The mean patient age was 49 years, 59% were Caucasian, and 71% female. Relationships averaged 4.6 years. On a 1-10 scale, patients' ratings of the relationship quality (median 9) significantly exceeded providers' ratings (median 5, p=0.002). Three major themes emerged: patients view relationships more positively than providers, the challenges of guarding emotions, and trust matters in challenging relationships.

Conclusion: Patients felt more positively about these relationships than providers perceived. Both sought ways to achieve mutual trust, despite barriers arising from guarded emotions.

Practice Implications: Providers in challenging relationships should consider exploring their patients' views, as they may feel reassured that patients appreciate their efforts and have trust in them.