"Hateful patients" are not those with whom the physician has an occasional personality clash. As defined here they are those whom most physicians dread. The insatiable dependence of "hateful patients" leads to behaviors that group them into four stereotypes: dependent clingers, entitled demanders, manipulative help-rejecters and self-destructive deniers. The physician' negative reactions constitute important clinical data that should facilitate better understanding and more appropriate psychological management for each. Clingers evoke aversion; their care requires limits on expectations for an intense doctor-patient relationship. Demanders evoke a wish to counterattack; such patients need to have their feelings of total entitlement rechanneled into a partnership that acknowledges their entitlement--not to unrealistic demands but to good medical care. Help-rejecters evoke depression; "sharing" their pessimism diminishes their notion that losing the symptom implies losing the doctor. Self-destructive deniers evoke feeling of malice; their management requires the physician to lower Faustian expectations of delivering perfect care.

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officer of every foundation faces pressure to show that money was spent wisely and made a difference. The same accountability exists in government. But understanding accountability is one thing; translating it into adequate evaluations is another. To counter this culture of nonobjective evaluations, the following proposition needs to be debated: All work funded by the government needs to be distributed and published in a timely manner. Such work should be used to influence policy and not be embargoed to benefit a special interest group, even if that special interest group is the US government. Health services researchers spend money that ultimately comes from taxpayers. These researchers should have a responsibility to report the results of investigations in a public database, where they can readily be found. Rapid access to all information produced from governmentsponsored work should be required.Third, such policies should extend to foundations. Foundation revenues are not taxed, so all contribute, at least indirectly, to the research and programs that foundations support. All foundation programs should be evaluated, and those results should be publicly released in a timely manner.In essence, the culture of the health services research field must facilitate rather than impede the flow of information. This will involve changes at both the policy and the community level. Importantly, individuals living in the United States need to understand that health care will improve only if information cannot be manipulated so that a chief executive officer or agency "looks good." They also must accept that some programs do not work out as expected and learn that social policy can be adjusted to make life better for everyone if intended as well as unintended policy consequences are quickly understood. Attempting to improve health and eliminate health disparities is difficult, and all creative solutions will not prove successful. The public needs to understand that if all programs succeed, the individuals designing them are too conservative or insufficiently creative.As a new political window for health care reform is approached, building trust and motivating collaboration between community members and the individuals who produce information about the system is critical. Without developing an informed community-based constituency that trusts this information, the likelihood of improving the health care system is slight. 1990;264(15):1953-1955. 7. Kosecoff J, Kahn KL, Rogers WH, et al. Prospective payment system and impairment at discharge: the "quicker-and-sicker" story revisited. JAMA. 1990; 264(15):1980-1983. Jones L, Wells K. Strategies for academic and clinician engagement in communityparticipatory partnered research.

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; this is a larger issue that needs the attention of medicine as a culture and a profession.The authors' data suggest that Facebook accounts may soon become prevalent among a large number of medical students, residents of all years, and attending physicians. Thompson et al. show that 20% to 30% of all medical students and first through third year residents have a Facebook account. Only in the more senior residency years does the prevalence of Facebook accounts fall off: 10% in fourth year residents and ultimately 0% in sixth year residents. Although possible, it is unlikely that residents had Facebook accounts early in their training, but then closed their accounts later in residency. Instead, the relative absence of Facebook accounts in senior years of residency is likely a cohort effect. Facebook, which began in 2004 as a way for college students to communicate, has grown rapidly to more than 90 million active users 2 . By nature of being a social network embedded in colleges and active for only the last four years, more senior residents likely do not have accounts simply because they were too old to be caught in Facebook's rise in popularity. A reasonable prediction is that as junior residents advance in training, we will see an increased prevalence of Facebook accounts in senior residents, presumably as high as the 20 to 30% seen in medical students. If the current trend holds true, the large prevalence of Facebook users will soon include young faculty and junior attendings. As the authors conclude, there is a role for medical schools, residency programs, and the ACGME in providing trainees with sound advice around the use of social networking sites. However, the increasing incidence of Facebook usage among all physicians calls for a broader discussion across medicine's organizing and accrediting bodies. Organizations such as the AMA should facilitate a national conversation and the production of general guidelines for all physicians to draw upon when posting and sharing personal information on online social network sites.