Roles of physicians and health care systems in “difficult” clinical encounters

Physicians are, by definition, contributing partners in “difficult” patient-physician encounters. Although research on relevant physician qualities is limited, common themes mirror the more extensive literature on physician burnout. Focusing on primary care, we discuss physician-level factors in difficult encounters related to psychosocial attitudes and self-awareness, communication skills, and practice environments. Potential approaches to mitigating these factors include changes to medical training, such as structured peer case discussion groups and communication skills development, and changes to workplace environments, such as integrated mental health. Modifying physician-level factors in difficult encounters could ease perceived difficulties and improve outcomes for both physicians and patients.