Most of us who care for patients can remember seeing a name on the schedule and feeling our heart sink.

What makes some clinical relationships so difficult? Is it something about the patient—or something about the interaction itself?

Dr Jeffrey Jackson has spent more than two decades studying this question. His research has shown that difficult encounters are associated not only with patient characteristics but also with physician factors, including the clinician's approach to psychosocial issues. In this conversation, we explore what his work can teach us about why encounters become difficult, how trust can gradually emerge, and why some of the patients that physicians initially dread eventually become among the most meaningful to care for.

Along the way, we discuss chronic pain, personality disorders, longitudinal relationships in primary care, the role of physician self-awareness, and the difference between caring for patients and trying to control them. This episode asks what it means to remain present with patients whose suffering—and whose behavior—challenge us the most.