We thank Dr Evans for his comment regarding our recent article.1 His survey findings serve to illuminate and further delineate characteristics of patients involved in difficult encounters with their physicians. We agree that a neutral term is best, and selected difficult encounters rather than difficult patients for this reason. Dr Evans' survey complements our work by adding several additional ways in which encounters are perceived as challenging or difficult by physicians. What strikes us is that among his top 5 issues, 4 (no shows, poor compliance, late arrivals, and not knowing medications) could be addressed through novel mechanisms such as patient navigators2,3 and care managers or simple reminder telephone calls. This suggests to us that in Dr Evans' work and in ours, a crucial message is that key aspects of difficult encounters can be identified, anticipated, and hopefully addressed in ways that are mutually beneficial for patients and physicians alike. We believe that our data and those provided by Dr Evans provide the means to preserve and enhance the partnership between patients and physicians, even when difficult encounters are predicted.
An PG, Rabatin JS, Manwell LB, Linzer M, Brown RL, Schwartz MD. The Difficult Clinical Encounter and Bothersome Patient Behaviors—Reply. Arch Intern Med. 2009;169(14):1336-1340. doi:10.1001/archinternmed.2009.228