When the doctor doesn’t like the patient

It was one of those honest admissions that usually go unvoiced: The doctor didn’t like the patient and felt pretty sure the patient didn’t like him either.

Their introduction didn’t go well and the relationship failed to improve during subsequent visits, Dr. Don Dizon, an oncologist, blogged recently at ASCO Connection. “As time passed, I resented having to see her and take care of her because despite what I perceived as my best efforts, I felt we had no real doctor-patient relationship,” he wrote.

But when he confessed to some of his colleagues that he disliked the patient, they were shocked that he would even say such a thing.

Do doctors have an obligation to like all their patients? Good question – and thought-provoking as well, judging from the amount of traction that Dr. Dizon’s blog entry gained online this past month and the comments it generated (here and here, for instance).

While many patients desire empathy (or, at the very least, some respect), it was clear from the comments that this isn’t the case for everyone.

“We are not teenaged girls and this is not Facebook,” was the response from one person. “I don’t care whether you ‘like’ me, any more than I care whether my plumber or pool guy ‘like’ me. Just do your job.”

It’s about the clinical care, not about who likes or dislikes whom, wrote someone else. “Put aside your ego, do your job, stop labeling and move on.”

The online discussion raised another question: Is it fair for doctors to want all their patients to be likable? “It can be a significant burden to have to be the doctor’s buddy and entertainment when feeling awful,” one person pointed out.

This whole issue of likable vs. non-likable patients (or, put another way, “good” vs. “bad” patients) is one that’s received considerable study. People who work in health care encounter all types of personalities, backgrounds and preferences among their patients, and they often see patients at their worst. Because health care essentially comes down to a transaction between human beings, how clinicians perceive their patients, and vice versa, inevitably becomes part of the equation.

Research seems to support that the quality of the doctor-patient relationship indeed makes a difference. One rather disturbing study, conducted in Canada a couple of years ago, found that doctors tended to underestimate the severity of pain in patients whom they disliked.

There also seem to be expectations on the part of clinicians for what constitutes a “good” (read: “likable”) patient. The Medical Dictionary, for example, defines it this way:

A patient who:

1. Provides reliable history and information.

2. Follows the prescribed regimen, drug therapy, or recommended change in lifestyle, if appropriate for the patient’s condition.

3. Reliably returns for check-up visits at appropriate intervals.

Being likable or agreeable doesn’t always benefit the patient’s care, however, especially when patients don’t speak up because they fear the doctor won’t like them for doing so.

The challenge, it seems, is how to manage the doctor-patient encounter without letting likes or dislikes become personal or dominate the relationship.

So how did Dr. Dizon work through his dislike of this particular patient? Ultimately he came to the realization that it’s OK for doctors to own their feelings and not feel compelled to like every patient they treat, he wrote. Nor did the patient have a duty to like him in return.

“It dawned on me that I was working so hard to make her like me (and vice versa), that it was affecting my ability to care for her,” he wrote. “Once I admitted to myself that it was okay to not like a patient, I was able to do what she wanted me to do – to be her doctor.”

11 thoughts on “When the doctor doesn’t like the patient

  1. This situation works both ways or am I reading this wrong. The dislike could involve discrimination of some type but no one wants to say or mention it due to the current state of our society. I and my wife have 7 children together, we have been together since highschool. We are both Native American and live on the Spirit Lake Reservation in North Dakota. All our children were born in Devils Lake,N.D. at the Mercy Hospital. We came across this female “nurse”, red head and I forget her name at this time but we both got bad “feelings” around her. She would NOT write in or give my 2nd oldest son my last name-Yankton, he got stuck using his mother name Jetty. We than ran into this same nurse when my 4th child, 3rd son was born and again she said we could not use my last name because we were not married, her reason. There still is a LOT of Prejudice in Devils Lake, even now we occasionally run into it.

    • Dana, I hope you stay tuned. I am working on an upcoming post about diversity in the health care workforce and how it relates to interactions with patients of diverse ethnic, cultural and racial backgrounds. I will keep your comments in mind.

  2. After I retired, I took a part-time job in a hospital, working as a medical records analyst. I noticed that most doctors often started their dictation with “this pleasant patient” or “this delightful patient.” I was told that pleasant or delightful patients were likeable. If the dictation started “the patient presents with . . . ” then they weren’t seen by the doctor as likeable.

    When I needed medical care, I always mentioned that I worked in medical records as an analyst.

  3. I Feel it is very difficult, for doctors to like all there patients. They have personal problems just like the rest of us. Or not getting enough sleep, I have bladder cancer My urologist did a wonderful job of surgery, But when i went to see after words with my daughter, I had questions and she kept saying we will get to that later. Then she leaves and i asked the nurse said she did not answer my questions she came back with an attitude. My daughter said we do not have to be treated that way and we were leaving, She sat down and we worked it out. My oncologist 2 that I have had are the best. They look at every thing Check every thing before they leave. Not every person likes every one. Not happy as patient find another Doctor. Doctors are human , people also. Not perfect.

  4. Patients don’t have to work on “entertaining” the doctor, I found that I usually disliked rude or aggressive patients.
    But the dr/pt relationship is very important, the pt has to feel comfortable with their dr to ask questions and feel that they are portably to the physician. Perhaps that is more true here in Spain and not in the US?

    How can one “leave apart” the non-liking of the patient?, I don’t have to “love” my patients, but feel a mutual trust &respect. If not, the medical care is not as good. I believe that you cannot put aside those feelings, the thecnical name is counter transference.
    When I feel that a doctor doesn’t “like” ie trust& respect me ,I move to another one inmediatelly, and I would advise people to do that.

    Just my opinion

    • I agree there should be some respect, or at least a basic level of civility. It seems more challenging to give (and receive) good care when the element of respect is absent, and I would guess this is a universal issue.

      It seems unrealistic to demand that doctors “like” all their patients. Even though the focus should be on the care provided and not on the patient’s likeability, the quality of the relationship and the communication are so intertwined with the clinical that it can be hard to separate them.

  5. The doctor I went to went so far as to say if we didnt like what he had to say we could walk out the door! I was shocked!

  6. the doctor I went to see for surgery was so rude, he told us if we didnt like what he had to say we could walk out the door. I was shocked

  7. I have learnt that it is not possibly to leave all aspects of what makes me human at home when I go to work as a doctor. Empathy, joy, sadness, impatience, frustration, anger, caring and understanding. So it is inevitable that during a working week I will run into someone who will trigger a negative emotion. Thankfully positive encounters outweigh the negative or otherwise I don’t think I would survive doing this job. It is worth remembering that when a patient provokes a negative emotion it could be because they are struggling with their own health issues. And often these may be related to mental health issues such as depression, addiction or personality disorders. Even so some patients can make it quite difficult to explore these especially when they say “you call yourself a doctor”!

  8. This works both ways I think. My husband is a doctor and I work in the office with him. The thing to remember is that being in the health care field, you are not seeing people at their best. If that were the case, then they would not be seeking medical advice and care. Some patients are more pleasant and grateful for the care they seek than others, and it is true that some people are more “likeable” than others, but that should not interfere with the care and empathy that they deserve and that you give them. I have experienced this on the other side of the spectrum as well. I have had doctors who obviously did not like me . They were hostile, unreceptive and did not listen to me. I think that this is the ultimate example of unprofessionalism. Whether you “like” someone or not, a doctor goes into that field to help other people. Displaying a dislike of someone or judging them on their personality has nothing to do with their medical care and should not become an issue with providing care for the patient. When that becomes an issue for the doctor, I believe they should re-evalute why they are in the profession of health care.

  9. I filed a complaint against my psychiatrist.

    Now the doctor holds a grudge against me.

    The doctor’s ego gets the best of him.

    The doctor sometimes tells me I am manic. My therapist doesn’t agree with the doctor’s opinion.

    The complaint was twenty seven months ago and the doctor still resents towards me.

    What would be my best option? The doctor thinks he is all knowing and how
    dare I file a complaint.

    Sincerely,
    Ken Auler

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