IntroductionPrevious research has shown that multiple factors contribute to healthcare providers perceiving encounters as difficult, and are related to both medical and non-medical demands.AimTo measure the prevalence and to identify predictors of encounters perceived as difficult by medical residents.Design and settingCross-sectional study at the Department of Ambulatory Care and Community Medicine (DACCM), a university outpatient clinic with a long tradition of caring for vulnerable patients.MethodWe identified difficult doctor–patient encounters using the validated Difficult Doctor–Patient Relationship Questionnaire (DDPRQ-10), and characterised patients using the patient’s vulnerability grid, a validated questionnaire measuring five domains of vulnerability, both completed by medical residents after each encounter. We used a multiple linear regression model with the outcome variable as the DDPRQ-10 score, controlling for resident characteristics.ParticipantsWe analysed 527 patient encounters performed by all 27 DACCM residents (17 women and 10 men). We asked each medical resident to evaluate 20 consecutive consultations starting on the same date.OutcomeOne hundred and fifty-seven encounters (29.8%) were perceived as difficult.ResultsAfter adjusting for differences among residents, all five domains of the patient vulnerability grid were independently associated with a difficult encounter: frequent healthcare user; psychological comorbidity; health comorbidity; risky behaviours and a precarious social situation.ConclusionNearly a third of encounters were perceived as difficult by medical residents in our university outpatient clinic that cares for a high proportion of vulnerable patients. This represents twice the average ratio of difficult encounters in general practice. All five domains of patient vulnerability appear to have partial explanatory power on medical residents’ perception of difficult patient encounters.

IntroductionStudies have documented poorer health among migrants than natives of several European countries, but little is known for Switzerland. We assessed the association between country of birth, socioeconomic factors and self-reported health (SRH) in a prospective cohort of adults living in Lausanne, Switzerland.MethodsWe used the data from the Colaus panel data study for three periods: 2003–2006 (n=6733), 2009–2012 (n=5064) and 2014–2017 (n=4555) corresponding to 35% of the source population. The response variable was SRH. Main explanatory variables were socioeconomic status, educational level, professional status, income, gender, age and years in Switzerland. The main covariate was country of birth, dichotomised as born in Switzerland or not. We specified random effects logistic regressions and used Bayesian methods for the inference.ResultsBeing born outside of Switzerland was not associated with worse SRH (OR 1.09, 95% CI 0.52 to 2.31). Several other patient variables were, however, predictive of poor health. Educational level was inversely associated with the risk of reporting poor health. Monthly household income showed a gradient where higher income was associated with lower odds of reporting poor SRH, for both for migrants and non-migrants. Migrant women had lower odds of reporting poor SRH than men (OR 0.73, 95% CI 0.55 to 0.98). Migrant people living in couple have less risk of reporting poor SRH than people who live alone and the risk is lower for migrant people living in couple with children (OR 0.66, 95% CI 0.55 to 0.80).DiscussionMigrant status was not associated with poorer SRH. However, differences in SRH were observed based on gender, age and several social determinants of health.

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