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February 23, 2009

Unburdening the Difficult Clinical Encounter

Arch Intern Med. 2009;169(4):333-334. doi:10.1001/archinternmed.2008.548

One must commend An and colleagues1 for examining a problem that, although pervasive in clinical practice, is understudied and seldom funded. This is not “disease-based” research but rather an investigation of the context and process of practice, in particular, the factors that may lead to a dysfunctional clinical encounter. Such research would broadly be classified under the rubric of “physican-patient relationships” or “health communication.” The authors were creative in attaching this secondary question to a study primarily funded as part of the national patient safety initiative. Although limited funding impedes research on difficult encounters, each small addition to this 1000-piece jigsaw puzzle makes the section completed more coherent and the parts to be filled in increasingly circumscribed. Every physician experiences difficult encounters on a daily basis. Although clinical research, medical school curricula, and continuing education focus predominantly on diseases, practitioners are confronted with a disease or illness manifested in a particular patient. In contrast to the popular book All I Really Need to Know I Learned in Kindergarten, the topic addressed by An and colleagues can be characterized as Much of What I Really Need to Practice I Learned After Medical School.