Damaged relationships with patients can be repaired by listening, empathizing, and setting clear limits and goals.

Reflective learning during and after challenging experiences can be used to foster medical students’ moral development and professional identity formation.

Physicians’ perceptions of “difficult” encounters are related to perceived workload, job satisfaction, and communication training, similar to burnout.

Five images capture the tensions in health care between dependency and autonomy, vulnerability and strength, and independence and dependence.

Physicians have an ethical responsibility to repair damaged relationships with patients stemming from their duty to treat and greater power.

When colleagues request treatment that is not medically indicated, clinicians should show empathy and respect without compromising judgment.

Clinicians should strive to see the dignity and humanity in patients characterized as “difficult” from a psychoanalytic perspective.

The AMA Code of Medical Ethics’ opinions related to moral psychology and “difficult” clinician-patient relationships.

Applying a virtue ethics approach—and especially the virtues of courage and compassion—enables clinicians to care appropriately for “difficult” patients.

“Difficult” patient-physician encounters have roots in uncertainty about individuals’ trustworthiness, clinicians’ skills and training, and medical science.