title: [Difficult consultations rather than difficult patients].
abstract: Here we describe two patients attending the internal medicine out-patient clinic. The first patient, a 43-year-old male, consulted a resident in internal medicine with irritable bowel syndrome and complications a year after surgery. The second patient, a 39-year-old female, was referred with medically unexplained symptoms. No treatable cause was found for either of these patients, and the encounters were unsatisfying for both the patient and the physician. According to the literature, 1 in 6 medical encounters is labelled as 'difficult' by the physician. Patients with medically unexplained or psychiatric disorders are frequently labelled as difficult, and young and inexperienced doctors more often report encounters as difficult. These difficult encounters have a negative influence on patients' satisfaction and physicians who experience many of their patients as difficult are more likely to experience burnout. More training in communication skills and psychosocial medicine may be helpful in reducing the number of difficult encounters.
authors.affiliation: Academisch Medisch Centrum Amsterdam, Netherlands. p.r.tuinman@amc.uva.nl
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Tuinman
authors.forename: H H Riëtta
authors.initials: HH
authors.lastname: Oberink
authors.forename: Margreet
authors.initials: M
authors.lastname: Wieringa-de Waard
authors.forename: Joost B L
authors.initials: JB
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000517:prevention & control; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006801:Humans; D007388:Internal Medicine; D007398:Interpersonal Relations; D008297:Male; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012017:Referral and Consultation