title: Caring for patients during challenging clinical encounters.
abstract: OBJECTIVE
  Challenging clinical encounters can often be frustrating and demoralizing not only for clinicians but also for patients. The paper's aims are twofold. The first is to analyse the nature and origins of such encounters. The second is to appraise the CALMER and REBELS models for managing them.
  
  
  METHODS
  After reviewing the medical literature on challenging clinical encounters, a clinical case is briefly reconstructed from it. The reconstructed case is then used to analyse the nature and origins of challenging encounters and to evaluate the two models for handling them.
  
  
  RESULTS
  The reconstructed clinical case is an apt example for examining and evaluating the medical literature on challenging clinical encounters. In terms of what challenging encounters are and what elicits them, the literature captures their frustrating, demoralizing, demanding and, at times, insufferable dimensions - as well as the role of patients in their origins - as the clinical case also illustrates. With respect to managing them, the CALMER and REBELS models are effective strategies for handling challenging encounters - again, as the clinical case exemplifies.
  
  
  CONCLUSIONS
  Although the clinical case supports the medical literature on challenging clinical encounters, the literature fails to provide an adequate account of their nature and origins. Specifically, challenging encounters are a type of dysfunction - not pathophysiological but existential - in a clinical setting, with their origins not only in patients but also in clinicians and health care systems. Finally, based upon the dysfunctional nature of such encounters, revisions of the CALMER and REBELS models are proposed for better managing these encounters.
authors: Department of Philosophy and Medical Humanities Program, Baylor University, Waco, TX, USA.
authors: James A
authors: JA
authors: Marcum
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010349:Patient Compliance / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D011369:Professional-Patient Relations
keywords: clinical safety; evaluation; person-centred medicine