Physician survival: should the doctor come first?

Difficult patients are common in family practice and take a toll of physicians which is out of proportion to the frequency or duration of their visits. Recognizing that the problem is in the physician-patient relationship is the first step in physician survival.This article reviews the roles physicians adopt with patients-"doctor as God", "patient in command" and "on the level". It points out strategies and tactics to use with the problem patient and suggests that putting the physician's wellbeing first results in better patient care.