The difficult patient and the physician-patient relationship.

This paper re-evaluates the concept of the difficult patient from the perspective of the physician-patient relationship. Specifically, patients that physicians define as difficult are seen as the product of failed relationships with physicians. A variety of reasons for failure of relationships between physicians and patients to lead to satisfactory outcomes is discussed. These reasons include failures of communication between patient and physician, failure of physicians to recognize the needs and expectations of patients, and failure of physicians to recognize the symbolic or phenomenological aspects of their patients' illnesses. Teachers of young family physicians need to incorporate models of medical care and compliance which involve the contribution of the physician as well as that of the patient.