Health care providers perceive """"""""difficult"""""""" patients to be a major problem of their clinical practices. Being perceived as difficult is troublesome for patients as well. However, despite the significance of the problem, no research studies systematically investigate how providers construct their perceptions of difficult patients or how such perceptions influence patient care. This proposal requests funds for a one year anthropological study to investigate the social construction of difficult elderly patients by health care providers in a large urban community hospital. It will examine how and why doctors and nurses in a geriatric outpatient clinic and a geriatric inpatient assessment and rehabilitation unit subjectively perceive the behaviors of some elderly patients as being difficult and investigate how such perceptions relate to their use of strategies to manage difficult patient behaviors. The central tasks of this research are: (1) to examine and compare within and between sites the ways in which doctors and nurses subjectively define and interpret difficult elderly patients; (2) to examine and compare within and between sites the strategies that doctors and nurses use to manage difficult elderly patients; (3) to examine the association between the ways in which providers define difficult patients and the strategies they use to manage such patients; and (4) to examine and compare within and between sites the consequences of providers' strategies both for themselves and their patients. This study will utilize methods for conducting intensive, empirically grounded, naturalistic field research. Data will derive from detailed long term observations, patient's medical records and a series of in-depth interviews with 30 doctors, 30 nurses and 30 patients.
