title: How respected family physicians manage difficult patient encounters.
abstract: BACKGROUND
  Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping.
  
  
  OBJECTIVE
  To describe how respected family physicians identify, manage, and cope with difficult patient encounters.
  
  
  METHODS
  Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes.
  
  
  RESULTS
  102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians' personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy.
  
  
  CONCLUSIONS
  We propose a model where clashes between patient behaviors and physicians' traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.
authors.affiliation: Department of Family Medicine, University of Cincinnati, Cincinnati, OH 45267-0582, USA. eldernc@fammed.uc.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Elder
authors.forename: Rick
authors.initials: R
authors.lastname: Ricer
authors.forename: Barbara
authors.initials: B
authors.lastname: Tobias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003220:Conflict, Psychological; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D014481:United States