A meta-analysis showed that nearly one-fifth of adult patient encounters in non-psychiatric settings are considered difficult by physicians[1]. The prevalence of such difficult encounters was 17% in 10 studies that measured this parameter[1]. In one cohort study, of 750 encounters, 133 (17.8%) were perceived as difficult by providers[1]. Severe patients were less likely to trust their doctor (RR = 0.88, 95% CI: 0.77–0.99), were less satisfied (RR = 0.78, 95% CI: 0.62–0.98) and had a higher risk of worsening symptoms at 2 weeks (RR = 1.33, 95% CI: 1.03–1.75)[1]. Patients perceived as severe had more physical symptoms, worse functional status, higher utilization of health care, higher severity of symptoms and more frequent psychiatric disorders[1]. Physicians with worse psychosocial attitudes and less clinical experience perceived more encounters as difficult[1]. Approximately 15% of patient encounters are perceived as difficult and are influenced by both patient and physician characteristics[1][3].