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JCOM Abstract

J Clin Outcomes Manage 
2012 Dec;19(12):557-562
Deconstructing difficult encounters
Laird-Fick HS, Freilich L, Han C, Smith R

Abstract Objective: To describe physician and patient factors that contribute to difficult encounters and to review evidence-based approaches to ameliorate their effects. Methods: Case presentation and discussion. Results: Physicians characterize up to 18% of patient encounters as “difficult.” Patients with mental health disorders, somatization, and psychosocial issues, in particular, can be challenging for clinicians. Less experienced, stressed, and biomedically focused physicians are more likely to report difficult encounters. Nearly all physicians have subconscious attitudes and behaviors that affect the doctor-patient relationship, a phenomenon known as “countertransference.” Patient-centered interviewing promotes effective care for these patients, but physicians often need to work on personal awareness to mitigate difficult interactions and prevent burnout. Conclusion: Physicians can learn to handle the emotions and external factors that contribute to difficult encounters.

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