[The problematic physician-patient encounter].

Abstract

The medical encounter between the physician and the patient may sometimes be difficult, with either or both participants feeling uncomfortable. To try to understand what transpires during an unsatisfactory encounter, it is essential to examine the parts played by the patient and the physician and the context in which the encounter takes place. A problematic patient for one physician may be an ordinary one for another. However, there are some patients who are difficult for most physicians. In this article, the traits of problematic patients are described, as well as personal and professional characteristics of physicians and various circumstances not directly related to the participants that may make the encounter difficult (overcrowded agenda, an external problem which a participant brings to the encounter, and so on). To improve the quality of the medical encounter the physician must first be aware when there is a problem. He must then identify the various causes of the "mutual disagreement" and the participant responsible for it. He must also increase his awareness of his own emotional reactions in order to arrive at a satisfactory personal solution.