Managing the care of the difficult patient in the emergency unit.

An approach to managing the care of "difficult" patients in emergency units is presented in both theoretical and practical terms. Understanding the conflicts these patients create and how these are exacerbated in an emergency unit setting can often lead to straightforward plans for management. These plans should emphasize consistency as a way of both setting limits and reassuring patients and should set reasonable expectations for health care providers working with these patients. Clinical examples are given to illustrate the use of these principles.