Problematic resident-patient relationships

OBJECTIVES: The objectives of the study were to identify the characteristics of a problematic doctor-patient relationship from the perspective of primary care patients who are cared for by medical residents and to determine whether patients' perception of the relationship is a function of their demographic, clinical, or social attributes. DESIGN: Cross-sectional survey. SETTING: An adult primary care practice in an academic medical center. PATIENTS: One hundred fifty-one patients whose primary care physicians were senior internal medicine residents. MEASUREMENTS AND MAIN RESULTS: Patients completed a questionnaire addressing several aspects of their doctor-patient relationship, the general health perception item on the SF-12, and items on social support from the Duke Social Support and Stress Scale. By design of the study, approximately half of the patients had been identified by their physicians as being in problematic relationships (n = 74) and half as being in satisfying relationships (n = 77). Among patients in relationships described as satisfying by their resident, 10% viewed the relationship as problematic. Of the patients involved in relationships described as problematic by the resident, 23% viewed their relationship as problematic (P = .03). Patients who rated the relationship as problematic were much more likely to also report low social support compared to patients involved in relationships described as satisfying (76% vs 16%; P < .001). Compared to residents involved in relationships described as satisfying by their patients, residents in problematic relationships were more likely to be described as being less accessible and less capable of handling medical complaints (P < . 001). CONCLUSIONS: Patients were more likely to describe the doctor-patient relationship as problematic if they felt that the resident was less accessible or less capable of handling medical complaints, or if they had low self-perceived social support.