Relational Strategies for Providing Rewarding Care When Patients Are "Difficult".

Managing the "difficult" patient or family is a constant feature of contemporary clinical practice. A vast literature has emerged that documents the frequency of these challenging interactions and attempts to assist providers in coping with them. Repeated interactions with challenging patients and families often result in psychological distress and burnout for the providers who care for them. As a result, to protect their psychological well-being, many providers employ a strategy of emotional avoidance with "difficult" patients that delivers competent and professional care without substantial interpersonal investment. But stories from providers who have not merely survived but thrived while taking care of challenging patients demonstrate that relational engagement is a more effective strategy for working with "difficult" patients. Increasing, rather than decreasing, the investment in such patients enables providers to move past perfunctory clinical care, which is enervating and unfulfilling, to a holistic approach that is not only personally gratifying for the provider, but generates demonstrably better clinical outcomes.