• Mario Alfredo De Marco, Vanessa Albuquerque Cítero, Maria Cezira Fantini Nogueira-Martins, Latife Yazigi, Lawrence Sagin Wissow, Luiz Antonio Nogueira-Martins, and Sergio Baxter Andreoli.
• Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
• Sao Paulo Med J. 2011 Jan 6; 129 (1): 5105-10.

Context And ObjectivePrevious 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.Design And SettingCross-sectional survey conducted in the hospital of Universidade Federal de São Paulo (Unifesp).MethodsThe 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.ResultsOn 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).ConclusionsUnderstanding 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.

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