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In the most recent Archives of Internal Medicine, investigators examined the pervasive but poorly understood issue of “the difficult patient encounter” (Arch Intern Med. 2009;169(4):410-414).  The authors write “Nearly 1 of 6 outpatient visits is considered difficult by physicians. Difficult encounters are more likely to occur with patients who have a mental disorder, present with more than 5 somatic symptoms, exhibit high use of health services, possess a list of complaints, or have threatening and abrasive personalities. Physicians report that they secretly hope that their challenging patients will not return and find that, in general, difficult encounters are time-consuming and personally and professionally unsatisfying. Although the attributes of challenging patients are well defined in the literature, the characteristics of physicians involved in high numbers of difficult encounters are less understood. For example, age and years in clinical practice have been inversely correlated with frequency of difficult encounters in some investigations, yet other studies have found no such relationship. Subspeciality physicians, compared with family physicians, are more frustrated by difficult encounters and feel ill-equipped to manage them, yet associations between difficult encounters and patient outcomes remain to be determined. We sought to compare levels of stress, burnout, satisfaction, time pressure, intent to leave the practice, and medical errors between primary care physicians who report having high numbers of difficult encounters with patients and those who do not.”

In their conclusion, they write, “Our results indicate the potential value of strategies to help physicians manage difficult encounters more effectively. Previously suggested coping mechanisms include demonstrating more empathy, practicing nonjudgmental listening, and communicating more directly with patients involved in difficult encounters. Increased training on approaching difficult encounters is warranted, as is the provision of more support personnel (eg, social service) and perhaps the allotment of more time for difficult encounters. Because of the prevalence of difficult encounters and their strong association with physician burnout and dissatisfaction, explicitly addressing difficult encounters in primary care is of considerable importance.”

In the accompanying editorial, Kurt Kroenke MD writes, “Celebrate the well-navigated difficult encounter. Dealing with difficulty signifies mastery rather than weakness. Olympic dives are rated in terms of difficulty, as are mountain climbs, hiking trails, musical works, crossword puzzles, and highly technical procedures. Partnering with patients in the challenging aspects of their health, lives, or medical care is a stepping stone to surmounting together the difficult encounter.”

So what does any of this have to do with Buddhism or mindfulness? Everything. I propose that the burgeoning evidence demonstrating that mindfulness practices can positively influence outcomes in a multiplicity of areas (as this webiste amply proves), can equally be applied to the area of the difficult patient encounter. Basic principles of mindfulness meditation can absolutely help physicians manage difficult encounters more effectively and can aid in the cultivation of mastery of the physician-patient relationship.