Difficult patient encounters are ubiquitous in inpatient and outpatient nephrology services. The chronic nature of renal disease and the requirement for long-term intensive treatment creates conditions for difficult interactions between the treating team and the patient. Patient, physician, and organizational factors are involved in the etiology of these encounters. Patient and physician factors include particular personality traits and personality disorders. Team morale and coherence are important in minimizing these encounters. Self-awareness by healthcare professionals and adopting the CONFLICT approach may be helpful.