The Psychiatric Times published “The ‘Hateful Patient” Revisited: A Transactional View of Difficult Physician-Patient Relations” in the June, 2015 issue. This article is expands upon an article published 35 year ago, “Taking Care of the Hateful Patient,” which has been used in many medical training programs. The original article identified 4 “archetypes” of patients who displace their “conflicts of past and present personal life onto the clinical relationship.” The original article use a psychoanalytic perspective and based the understanding of the archetypes on attachment theory. The current article provides an update on the original, starting with, thankfully, replacing “hateful” with “difficult.” The author, Greg Sazima, M.D., adds 3 physician archetypes: perfectionist, narcissistic and counter-dependent, and describes common problematic patient-physician cycles of difficult interactions. He provided insights into what physicians can do to alter these cycles, but emphasizes that this requires that physicians have enough self-awareness to recognize their own contributions to the problem.

My take: it is interesting to learn about how physician colleagues are training to respond to difficult patients. The training program, even in its expanded and updated form, is a bit simplistic and also seems more aspirational than pragmatic- I wonder how my busy physicians have the detailed knowledge of the system and time necessary to adequately implement it. I suspect that many MDs would appreciate being able to refer these patients to therapists with some knowledge of this system, but a higher level of skills for helping the patient-physician “couple” with their relationship problems.

The article may be accessed at:

To access it you must be a member of the UBM Medica Network (not apparently connected with the Medica insurance company), which is free and just takes a few minutes to complete.

Tagged on:

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.