Difficult patients seem to be those who tend to put stress upon the physician's narcissistic balance through their extremely demanding or extremely seductive behavior in the relationship. The authors believe that the problem of the difficult patient is actually the problem of the difficult doctor-patient relationship. They offer some practical suggestions for withstanding the impact of such patients, which they group under the rubrics of perspective, detachment, and confidence. Management of the physician's personal vulnerability is essential to a successful outcome. Peace of mind of those specialists whose practice tends to foster one-to-one isolation with patients—dentists, dermatologists, ophthalmologists, otolaryngologists, and psychiatrists—is particularly at risk. It may be maintained through enhanced communication with peers. Modification of patterns of practice and psychotherapy are suggested to combat the adverse effects of stressful medical practice.