The "hateful resident".

In a 1978 article entitled “Taking Care of the Hateful Patient” James Groves1 identified 4 types of patients who induce “hateful” feelings in medical providers. The 4 types overlap considerably with personality disorders (table). Groves' seminal article identified a common, yet hidden fact of patient care—that certain patients evoke strongly negative feelings in their providers. This insight runs counter to the ideal that providers should “love” all of their patients. Having hateful feelings toward difficult patients is normal and can provide useful diagnostic information. Awareness and acceptance of these feelings can lead to better outcomes, both for providers and the patients they serve. The relevance of Groves' initial article to contemporary medical practice is demonstrated by the fact that multiple articles based on his model, many evidence-based, have been, and continue to be, written since its initial publication.2 TABLE Overview of Categories In our experience, Groves' insights are applicable to residency education. Physicians are a cross-section of the general population and may exhibit many of the same challenging behavioral patterns in their interactions with others. “Hateful residents” can be characterized into the same 4 categories that Groves uses to describe “hateful patients” and they evoke similar negative emotions (table). Such hateful residents may take up an inordinate amount of educators' time, frustrate efforts by these educators to assist them, and resist efforts to be remediated.3 Consequently, upon graduation these residents are challenged with finding faculty who will write positive letters of recommendation for them.4 Hateful residents exhibit inadequate professionalism and/or interpersonal communication, yet traditional evaluation methods used in residency education often fail to identify these deficiencies clearly and early in their training.5 Our goal in writing this article is to use Groves' typology to help residency educators identify specific categories of hateful residents early on in their training, make appropriate assessments, and implement useful strategies for remediation. Educators hoping to manage stress levels generated from the difficult issues posed by these residents will do well to consult with, and gain emotional support from, other colleagues or by presenting such cases in Balint groups or other personal and professional development groups.6 With difficult residents, as with difficult patients, one does not want to “fly solo.”