Part I: the difficult patient: medical and legal approaches

Difficult patients are defined as those who elicit strong negative emotions from their physicians. If not acknowledged and managed correctly, these feelings can lead to diagnostic errors, unpleasant confrontations, and troublesome complaints or legal claims. The author reviews common personalities and situations that are associated with difficult encounters in emergency departments and describes an approach stressing flexibility in communication and the early establishment of rapport. He discusses diagnostic possibilities in the agitated or confused, unco-operative patient, reviews relevant laws governing restraint and competence to consent, and outlines techniques to reduce medicolegal risks.