Editorial |

Unburdening the Difficult Clinical Encounter

Kurt Kroenke, MD
Arch Intern Med. 2009;169(4):333-334. doi:10.1001/archinternmed.2008.548.
Text Size: A A A
Published online


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.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 9

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles