Care of the Difficult Patient

Living reference work entry


Although the chapter title and some of the references included here will use the phrases “difficult patient” or “frustrating patient” – or even “hateful patient” – it should be made clear that this is not the author’s preferred term. Any doctor/patient interaction by definition involves at least two parties, both of whom have personalities, preconceptions, and prior experiences that are incorporated into current interactions. Difficulties in physician/patient interactions also incorporate patient, physician, and healthcare system factors [1]. For these reasons, phrases such as difficult or challenging patient interactions are preferred.


Personality Disorder Difficult Patient Family Medicine Physician Balint Group Challenging Interaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Haas LJ, Leiser JP, Magill MK, Sanyer ON. Management of the difficult patient. Am Fam Physician. 2005;72(10):2063–8.PubMedGoogle Scholar
  2. 2.
  3. 3.
    Lin EH, Katon W, Von Korff M, Bush T, Lipscomb P, Russo J, et al. Frustrating patients: physician and patient perspectives among distressed high users of medical services. J Gen Intern Med. 1991;6(3):241–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Hahn SR, Kroenke K, Spitzer RL, Brody D, Williams JB, Linzer M, et al. The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med. 1996;11(1):1–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Blake V. When is a patient-physician relationship established? Virtual Mentor. 2012;14(5):403–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Berger M. Chronically diseased patients and their doctors. Med Teach. 2002;24(6):642–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Pembroke N. Human dimension in medical care: insights from Buber and Marcel. South Med J. 2010;103(12):1210–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9.PubMedCrossRefGoogle Scholar
  9. 9.
    van Mook WN, Gorter SL, Kieboom W, Castermans MG, de Feijter J, de Grave WS, et al. Poor professionalism identified through investigation of unsolicited healthcare complaints. Postgrad Med J. 2012;88(1042):443–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Berry LL, Parish JT, Janakiraman R, Ogburn-Russell L, Couchman GR, Rayburn WL, et al. Patients’ commitment to their primary physician and why it matters. Ann Fam Med. 2008;6(1):6–13.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Kaplan SH, Greenfield S, Ware Jr JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 Suppl):S110–27.PubMedCrossRefGoogle Scholar
  12. 12.
    Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Riess H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(4), e94207.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med. 1999;159(10):1069–75.PubMedCrossRefGoogle Scholar
  14. 14.
    Steinmetz D, Tabenkin H. The ‘difficult patient’ as perceived by family physicians. Fam Pract. 2001;18(5):495–500.PubMedCrossRefGoogle Scholar
  15. 15.
    An PG, Rabatin JS, Manwell LB, Linzer M, Brown RL, Schwartz MD, et al. Burden of difficult encounters in primary care: data from the minimizing error, maximizing outcomes study. Arch Intern Med. 2009;169(4):410–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Boutin-Foster C, Charlson ME. Problematic resident-patient relationships: the patient’ s perspective. J Gen Intern Med. 2001;16(11):750–4.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Elder N, Ricer R, Tobias B. How respected family physicians manage difficult patient encounters. J Am Board Fam Med. 2006;19(6):533–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298(16):883–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Strous RD, Ulman AM, Kotler M. The hateful patient revisited: relevance for 21st century medicine. Eur J Intern Med. 2006;17(6):387–93.PubMedCrossRefGoogle Scholar
  20. 20.
    Schafer S, Nowlis DP. Personality disorders among difficult patients. Arch Fam Med. 1998;7(2):126–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Angstman KB, Rasmussen NH. Personality disorders: review and clinical application in daily practice. Am Fam Physician. 2011;84(11):1253–60.PubMedGoogle Scholar
  22. 22.
    Levinson W, Stiles WB, Inui TS, Engle R. Physician frustration in communicating with patients. Med Care. 1993;31(4):285–95.PubMedCrossRefGoogle Scholar
  23. 23.
    Mathers N, Jones N, Hannay D. Heartsink patients: a study of their general practitioners. Br J Gen Pract. 1995;45(395):293–6.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Krebs EE, Garrett JM, Konrad TR. The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC Health Serv Res. 2006;6:128.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD. How are patients’ specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians? J Gen Intern Med. 2002;17(1):29–39.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Cannarella Lorenzetti R, Jacques CH, Donovan C, Cottrell S, Buck J. Managing difficult encounters: understanding physician, patient, and situational factors. Am Fam Physician. 2013;87(6):419–25.PubMedGoogle Scholar
  27. 27.
    Kemp White M, Keller VF. Difficult clinician-patient relationships. JCOM. 1998;5(5):32–6.Google Scholar
  28. 28.
    Walker EA, Unutzer J, Katon WJ. Understanding and caring for the distressed patient with multiple medically unexplained symptoms. J Am Board Fam Pract. 1998;11(5):347–56.PubMedCrossRefGoogle Scholar
  29. 29.
    Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Lang F, Floyd MR, Beine KL. Clues to patients’ explanations and concerns about their illnesses. A call for active listening. Arch Fam Med. 2000;9(3):222–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Jackson JL, Kroenke K. The effect of unmet expectations among adults presenting with physical symptoms. Ann Intern Med. 2001;134(9 Pt 2):889–97.PubMedCrossRefGoogle Scholar
  32. 32.
    Pomm HA, Shahady E, Pomm RM. The CALMER approach: teaching learners six steps to serenity when dealing with difficult patients. Fam Med. 2004;36(7):467–9.PubMedGoogle Scholar
  33. 33.
    Sanyer ON, Fortenberry K. Using mindfulness techniques to improve difficult clinical encounters. Am Fam Phys. 2013;87(6):402.Google Scholar
  34. 34.
    Halpern J. Empathy and patient-physician conflicts. J Gen Intern Med. 2007;22(5):696–700.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Balint M. The doctor, his patient and the illness. 2nd ed. London: Churchill Livingstone; 2005.Google Scholar
  36. 36.
    Kjeldmand D, Holmstrom I. Balint groups as a means to increase job satisfaction and prevent burnout among general practitioners. Ann Fam Med. 2008;6(2):138–45.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Brookfield SD. Assessing critical thinking. New Dir Adult Continuing Educ. 1997;1997(75):17–29.CrossRefGoogle Scholar
  38. 38.
    Edgoose JY, Regner CJ, Zakletskaia LI. BREATHE OUT: a randomized controlled trial of a structured intervention to improve clinician satisfaction with “difficult” visits. J Am Board Fam Med. 2015;28(1):13–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Family Medicine and Population HealthVirginia Commonwealth University School of MedicineRichmondUSA

Personalised recommendations