The article is devoted to psychological problems of communicating tough patients. The tough patient notion is determined and their number increase causes are shown. It is noted that patients with depressive disorders and the character anxious and suspectful accentuation are the most difficult to communicate. The neurophysiological motivations of those patients’ behavior psychosomatic features and stereotypes are discussed. Some recommendations concerning optimization of the communicating tough patients and managing conflict situations are presented. The importance of improving the doctor’s communicative skills is stressed, Balint- and T-groups favoring the tough patients communication skills improvement are characterized.