“My intern can't stand Ms. Andrews and refuses to meet with her. He says I'll do all the communicating for the team and that I shouldn't be too nice to her so she won't split us. The attending says she's a classic borderline.” So began a student's presentation on “Difficult Patient Rounds,” my unofficial name for an exercise I started a few years ago with groups of four to five third-year students during their medicine clerkship. As a psychiatrist and card-carrying biopsychosocialist, I wanted to offer students some practical tips for working with patients who drove their caregivers to distraction. On this particular day, that description applied to Ms. Andrews, who was distressingly familiar to the medical service. Homeless and addicted to drugs and alcohol, she had terrible coping skills, a nasty temper, and a habit of leaving against medical advice after tormenting everyone for a few miserable days. Admitted — yet again — for pancreatitis, she was doing battle — as usual — over dilaudid and cigarettes. We spent half an hour trying to discover what made her tick.