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How to keep cool, provide great care during challenging encounters

September 13, 2022

Editor's note:  For more coverage of the 2022 AAP National Conference & Exhibition, visit

Cora C. Breuner, M.D., M.P.H., FAAP, has given a talk on how to handle difficult interactions with patients and families numerous times. This year, however, she is switching it up a bit to look at encounters through an equity lens and to address challenges due to COVID-19.

But her main message remains the same: When you encounter a patient or parent who is angry, demanding or noncompliant, it’s important to be aware of your reaction so you can attend to your emotions and provide the best possible care.

Dr. Breuner, professor in the Department of Pediatrics, Adolescent Medicine Division at Seattle Children’s Hospital and University of Washington, will provide strategies to deliver high-quality, equitable care during the session “Dealing With Difficult and Challenging Interactions” (S1314) from 4-5 p.m. PDT Friday, Oct. 7 in rooms 257.5-260 of the convention center.

Dr. Breuner, who was treated for stage 4 breast cancer in 2017, can relate to patients who become emotional.

“There were a couple times where I was not super cool when I called in,” Dr. Breuner said. For example, she became “snappy” with someone who refused to let her speak to her doctor shortly after the office closed. Later, she apologized, saying, “I'm really sorry I was short with you. It was not my intent.”

Dr. Breuner’s interest in the topic predates her own experience as a patient. In 2010, she realized that as a pediatrician, she was struggling with some patient encounters and needed some guidance. She looked in the literature and found a 1978 article by James E. Groves, M.D., in the New England Journal of Medicine that described four types of challenging behaviors. However, there was little related to pediatrics.

So in 2011, she co-authored an article in Pediatrics titled “Approaches to the Difficult Patient/Parent Encounter.” The article includes four vignettes that illustrate each type of behavior described by Dr. Groves: dependent clinger, entitled demander, manipulative help rejecter and self-destructive deniers.

During her presentation, Dr. Breuner will describe the four types of behavior and offer strategies to handle each one. She also will emphasize the importance of pediatricians recognizing their own physical and emotional reactions, such as anger, exhaustion or hopelessness, to such behaviors.

“Much of my talk is not about labeling the patients as much as labeling what you feel and your response and how best to manage them,” said Dr. Breuner, a member of the AAP Section on Integrative Medicine Executive Committee and Section on Adolescent Health.

She also will discuss how one’s implicit biases toward a person of a different race, ethnicity, size or gender could lead to labeling an encounter as challenging. She will encourage attendees to “notice right away what privilege you bring into the room and reflect on how best to make sure that your patient gets equitable, excellent care.”

Finally, she encourages attendees to bring questions about situations they have encountered.

“They're going to learn tools,” she said, “and they're going to leave with recognition that they're not alone, that there are other folks who are in the exact same situation as them.”

For more information on the National Conference, visit View the conference schedule at

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