Obstacles to the delivery of psychiatric care to transplant recipients and dialysis patients.

Despite treatment gains in knowledge about the psychological difficulties of patients with end-stage-renal disease, the psychiatric morbidity of this patient population remains critically high. This paper explores in detail and with several clinical illustrations the variety of "resistances" that stand as obstacles to the effective delivery of psychiatric care to transplant recipients and dialysis patients. These obstacles can be classified in three broad areas: 1) resistances posed by the ESRD patients, 2) interferences created by the medical staff, and 3) those resistances created by psychiatrists themselves. In addition to providing many examples of these resistances, this paper explores the underlying dynamic issues that are involved and suggests ways by which the delivery of psychiatric care to ESRD patients can be improved.