Beyond the "difficult patient": Relational acuity as a dimension of clinical care.

Abstract

Hospitalists routinely encounter episodes of relational strain marked by distrust, frustration, escalating emotion, or misaligned expectations. Often labeled "difficult" encounters, these interactions are better understood as dynamic relational states that can disrupt communication, erode therapeutic alignment, and complicate care. In this perspective piece, we propose the construct of relational acuity: a clinical lens for recognizing moments of heightened relational strain that signal increased relational need. We introduce a practical four-part framework: Recognition, Regulation, Realignment, and Repair, to help clinicians identify these encounters early, respond intentionally, and preserve the therapeutic relationship and the trajectory of care.