I once cared for a patient for 10 years, which is a pleasingly long time in oncology. Alas, the years didn’t bond us. I found her, in turns, combative and annoying, and I confess she probably found me the same. Before each encounter, I would take a deep breath and talk myself into greeting her with an ease I never felt.

She was my “heart-sink” patient. When she didn’t show up, I worried, but when she did, my stomach tightened. My “surface feeling” was impatience, but inside, I felt terrible that any patient should arouse such antipathy in a member of the “caring profession”. When she was finally discharged in good health, we were both relieved for different reasons.

I found myself thinking about this when reading an illuminating study about what makes “difficult” patients difficult. (I do love that doctors choose to study such things.)

The authors interrogated studies from different countries and different non-psychiatric settings including primary care, emergency, inpatient and specialty clinics. Twenty-eight of the 45 studies used a reliable instrument called the Difficult Doctor-Patient Relationship Questionnaire, a self-administered tool completed by the doctor to identify patients whose care was experienced as difficult.

How time consuming is caring for this patient?

To what extent are you frustrated by this patient’s vague complaints?

Do you find yourself secretly hoping this patient will not return?

How difficult is it to communicate with this patient?

How........

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