The factors contributing to a challenging interaction between the roles of patient and physician may come from several sources. Each interrelation has its own modus operandis in which one of the individuals may not condone the persona the other individual is portraying. A mental illness or diagnosis is often stigmatised by the burden of stereotypical bizarre associations. That means the patient is generally not guilty and this is not another label they should carry. Though the mental health professional should be impervious to this, some degree of discomfort may throw some shadow on the clinical mediation of the interview and management of the pathology.

To provide an overview of what is beyond the label “difficult patient” in mental health care.

Evaluation of conflicts inside the patient-illness-physician triad.

Search for articles in Pubmed, Athens, Google Scholar databases, along with the hospital library.

Characteristics of problematic interactions in psychiatric care were described consistently across our references. Causality for these difficulties is vast and surpasses the patient's behaviour. Plus they are not unique in psychiatry. They can be explained by individual, interpersonal, and social factors.

Situational issues, along with patient and physician characteristics, modulate and frame what should potentially be a productive encounter. To become aware of what contributes to difficult clinical encounters and to be prepared to address them while cultivating good interpersonal communication skills is fundamental.

The authors have not supplied their declaration of competing interest.