Interactional approach to the difficult emergency department patient

An area of emergency medicine often overlooked is the management of physician-patient relationships. In the Department of Emergency Medicine, University of Cincinnati Medical Center, we use a method for facilitating difficult physician-patient interactions that includes presentation of case-study vignettes followed by recommendations for preventing or ameliorating undesirable interactions. Five of these vignettes are examined here, followed by commentary specific to the individual cases. General principles of action include letting patients or relatives have their say, remaining calm, empathic, courteous, objective and sharing information with patients.