title: Medical residency: factors relating to "difficulty in helping" in the resident physician-patient relationship.
abstract: OBJECTIVE
  Previous studies have attempted to understand what leads physicians to label patients as 'difficult'. Understanding this process is particularly important for resident physicians, who are developing attitudes that may have long-term impact on their interactions with patients. The aim of this study was to distinguish between patients' self-rated emotional state (anxiety and depression) and residents' perceptions of that state as a predictor of patients being considered difficult.
  
  
  METHODS
  Cross-sectional survey conducted in the hospital of Universidade Federal de São Paulo (Unifesp).
  
  
  METHODS
  The residents completed a sociodemographic questionnaire and rated their patients using the Hospital Anxiety and Depression Scale (HADS) and Difficulty in Helping the Patient Questionnaire (DTH). The patients completed HADS independently and were rated using the Karnofsky Performance Status scale.
  
  
  RESULTS
  On average, the residents rated the patients as presenting little difficulty. The residents' ratings of difficulty presented an association with their ratings for patient depression (r = 0.35, P = 0.03) and anxiety (r = 0.46, P = 0.02), but not with patients' self-ratings for depression and anxiety. Residents from distant cities were more likely to rate patients as difficult to help than were residents from the city of the hospital (mean score of 1.93 versus 1.07; P = 0.04).
  
  
  CONCLUSIONS
  Understanding what leads residents to label patients as having depression and anxiety problems may be a productive approach towards reducing perceived difficulty. Residents from distant cities may be more likely to find their patients difficult.
authors: Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Mario Alfredo
authors: MA
authors: De Marco
authors: Vanessa Albuquerque
authors: VA
authors: Cítero
authors: Maria Cezira Fantini
authors: MC
authors: Nogueira-Martins
authors: Latife
authors: L
authors: Yazigi
authors: Lawrence Sagin
authors: LS
authors: Wissow
authors: Luiz Antonio
authors: LA
authors: Nogueira-Martins
authors: Sergio Baxter
authors: SB
authors: Andreoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D007396:Internship and Residency; D017567:Karnofsky Performance Status; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult