Managing ‘Difficult’ Patient Encounters

Donald W. Black, MD


Curr Psychiatr. 2021;20(7):13-19. 

In This Article

Describing the ‘Difficult’ Patient

In a landmark 1978 paper, Groves[7] provided one of the first descriptions of “difficult” patients. His colorful observations continue to provide useful insights. Groves emphasized that most medical texts ignore the issue of difficult patients and provide little or no guidance—which is still true 43 years later. He observed that physicians cannot avoid occasional negative feelings toward some patients. Further, Groves suggested that countertransference is often at the root of hateful reactions, a process he defines as “conscious or unconscious unbidden and unwanted hostile or sexual feelings toward the patient.”[7]Table 1[7] outlines how Groves divided “hateful” patients into several categories, and how physicians might respond to such patients.