Nobility

• Knowledge, attitudes, practice
• Physician role
• Physician-patient relations

Some years ago, my wife and I conducted a study of medical patients who were disliked by their physicians (1). The hardest part was getting the physicians to admit that they harbored any such emotions. “I like all my patients,” was a frequent reply.

Not me. I have never had trouble disliking patients. One could say that I have a highly developed sense of dislike, so acute that I sometimes use it as a diagnostic tool. When confronted with a patient I dislike, I screen for depression and alcohol abuse because I'd otherwise invariably miss those diagnoses, and I am likely to react negatively to such patients.

Whatever my initial emotional reaction to patients, it is difficult for me to dislike any of them for a prolonged period. I get to know them too well. They become far too interesting.

Mrs. Smedley was 77 when I first met her, accompanied by as long-suffering a daughter-in-law as I have ever encountered. Mrs. Smedley, newly arrived in Galveston from rural Texas, was carrying a list of diagnoses that would choke an HMO. She had systemic lupus erythematosus and discoid lupus (her italics, not mine), along with osteoporosis, several varieties of heart disease, arthritis, emphysema, a bad stomach, and chronic headaches. And she was miserable. My initial 90 minutes with her were as exhausting as a marathon.

I reeled from one symptom to the other in total confusion. It was a battle; as soon as I began to pin down one set of complaints, she would switch fields and bring up …