Working with the difficult patient

Patients who evoke emotional reactions in the family physician tend to be labelled "difficult". The difficult patient might be one who "yes . . . but" 's every suggestion, or who demands that the physician provide something inappropriate, like drugs or an unjustifiable letter. Whenever such an interaction occurs, the family physician can expect aggravation, frustration and, often, anger, and the results are likely to be unsatisfactory for both doctor and patient. This article describes an approach which will help the doctor to decide what actually to say or do in response to a difficult patient, especially within the time frame of the short office visit.