Managing the difficult patient requires a set of skills or strategies oriented at improving the physician–patient relationship and avoiding conflictive situations. There are different types of difficult patients who should be precisely identified for their management. These patients seek appropriate medical care which is not always provided. However, some may have unrecognized pathological illnesses, especially personality or psychiatry disorders. Clinical communications may be altered by professional and situational factors. In some circumstances, clinical symptoms are medically unexplainable or poorly defined as part of a disease or syndrome. Organic disease should be ruled out before patients are classified as having a somatoform disorder. Diagnosis may be delayed when symptoms are not properly evaluated therefore causing serious health consequences. Clinical competence, empathy, and high quality communication is required to succeed in difficult clinical encounters.