ABSTRACT: Patient-related, physician-related, and situational factors contribute to challenging clinical encounters. Patient-related factors include psychiatric illness, such as depression, anxiety, posttraumatic stress disorder, substance use disorders, and borderline personality disorder, but primarily involve personality traits and medically unexplained physical symptoms. Understanding the needs, motivation, and attachment styles of patients can help the obstetrician–gynecologist develop empathy for difficult patients, more effectively manage potentially challenging clinical encounters, better meet patient needs, and enhance their own job satisfaction. Resources and techniques available to physicians to minimize challenging encounters include the use of patient-centered interviewing and motivational interviewing; consultation with colleagues, including psychiatric consultation; and participation in Balint groups
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