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Am J Hosp Palliat Care. 2016 Feb;33(1):64-8. doi: 10.1177/1049909114552126. Epub 2014 Sep 23.

The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.

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Kaiser Foundation Hospitals, San Diego Medical Center, San Diego, CA, USA.
Division of Hospice and Palliative Medicine, Allegheny Health Network, Pittsburgh, PA, USA


Approximately 15% of patients are perceived by clinicians as "difficult." Early theories about difficult patients focused on patients' and clinicians' characteristics, often underemphasizing the influence of the environment on patients' behavior. The Stanford Prison Experiment, a classic experiment in the psychology of human behavior, provides a broader systems approach for understanding the environmental influences on patient behavior. A systems approach to the care of the difficult patient takes into consideration not only the patient's characteristics but also the health care environment and the more distal environments (ie, familial, societal, and cultural). Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters.


doctor–patient communication; empathy medical; medical education clinical skills; patient satisfaction; physician empathy; physician–patient relationship

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