At ACR yesterday, Dennis Boyle, MD, led an entertaining, interactive session on dealing with difficult patients. In addition to clips from Cool Hand Luke, he offered some perspective on the visits that no one wants to have.
First, recognize that you bring your own issues to the encounter, which will affect how you respond to the patient. Dr. Boyle described how he used to complain about his problem patients to a psychiatrist friend until the shrink asked, "Did you realize that all your difficult patients remind you of your mother?"
More seriously, he reminded attendees that most angry patients are actually more afraid or sad than angry, and that open-ended questions ("Tell me why...") should be used to get their story. It's also important to actually listen to them when they're talking, and use reflective listening ("It sounds like...") to make patients feel understood, to control rambling stories, and to help you remember details for later charting.