Doctor factors
•Lack of time (real or perceived).
•Inadequate clinical information.
•Inadequate clinical skills.
•Inadequate communication skills: eg. talking too much, using too many closed questions, not responding to patient’s agenda, inability to understand and communicate with people from different cultures and backgrounds.
•Attitudinal problems: boredom, lack of interest in psycho-social aspects of illness, burn-out, stress, fatigue, mental illness, prejudice and discrimination, difficulty handling strong emotions or accepting failure: difficulty coping with threats to competence.
•Poor recovery from previous stressful consultation.
•Hangry!
Patient factors.
- Lack of time (real or perceived)
- Fear (of doctors, pain and dying) Aggression.
- Lack of understanding of basic biology and probability.
- Unscientific health beliefs.
- Unrealistic expectations of the health service / medicine.
- Inadequate communication skills (over/under assertiveness)
- Coercion.
- Disability.
- Language deficeit
- Mental illness – insight / capacity.