Rethinking the difficult patient encounter.

Laura is a 49-year-old woman with posttraumatic stress disorder and chronic headaches who takes 200 mg of morphine twice daily and is in an electric wheelchair for no clear reason. Peter is a 53-year-old, morbidly obese man with poorly controlled Type 2 diabetes mellitus. Despite multiple visits focusing on lifestyle changes and medication adjustments, his A1C remains wildly uncontrolled and his weight continues to climb. Deborah is a 54-year-old woman with multiple medical problems, all relatively well controlled. She has depression and generalized anxiety disorder and feels she must be seen every two weeks. Edward is a 62-year-old polyglot and mathematician who brings a long list of complaints and a textbook about herpes simplex virus to his visits because he believes that all of his symptoms are due to the virus. Just reading these stories of “difficult” patients can feel draining. Patients like these can be challenging and exhausting, and they can fill you and your staff with a sense of dread. They may even make you wish for more patients with otitis media and urinary tract infections. However, they can also become some of the most beloved and professionally rewarding patients you will ever see. This article offers a simple strategy for effectively working with them.