ABSTRACT
This chapter explores how general practitioners might manage the difficult patient, the heart sink patient and the demanding and manipulative patient. It examines why medicine tends to categorise them in this way. A large number of ‘difficult’ patients referred to the chronic pain clinic have been victims of childhood sexual, emotional or physical abuse. For the chronic pain patient (and many patients in primary care) psychological treatment now equates to cognitive behavioural therapy (CBT), either on an individual basis or in groups through pain management programmes. There is also a danger that the clinician falls back into the trap of dualism and approaches the patient with the concept that the pain is all psychological. The chapter discusses the explanatory gap, as well as the Reductive and Lean models of healthcare Provision of a reparative relationship is not the sole preserve of the psychotherapist but does require relevant training of selected healthcare professionals.
