What do you do if you just don’t like someone -or in the context of a doctor/patient relationship, what should you do? It’s a vexing question at the best of times, but perhaps even more so if you are a patient that has been referred to a specialist. Or you are that specialist…

The question assumes a different dynamic when it is viewed from the perspective of non-urgent healthcare -something with which I suspect we are all familiar. Not to be misunderstood: all healthcare is important. Health is not trivial, nor is the individual perception of it. Nuisances loom almost as large as burdens or hazards in many of our otherwise unthreatened lives. And the very concept of Health itself could likely use a more compelling definition. But that aside, the problem remains: having decided that something requires a diagnosis and hence a remedy, and having been informed that the help in question is only available outside the warm and reassuring nest of the family doctor, what if there is an unbridgeable gap? What if you feel that you simply cannot confide in the specialist? That he will not listen to you? That he will not take your condition or your suffering seriously? That you, in the final analysis, don’t like him?

There are many facets to this problem certainly, but in the end most of it boils down to trust, not to mention respect. On both sides.

In an emergency -an accident, say- the problem of trust is perhaps more secondary: if you’re bleeding, you need someone to stop the bleeding, attend to whatever injuries have been sustained -fix the problem as it were. Only in the recovery phase -the sober reflection phase- does trust re-enter. But that’s after the fact; analysis is usually suspended in the face of dire need. In other situations, things are in many ways more complex: there is time for choice -time, in other words for preference. Trust. Belief. Much in medicine depends on belief: belief that there is help, belief that you can be helped and of course, belief that the doctor is capable of helping you. Think of belief -trust- as being the Supreme Placebo. It is the underlying understanding that hope for recovery is justified. Some situations require less of it -an appendectomy will likely cure appendicitis whatever you think; some situations more: chronic pain, for example. Most conditions probably fall somewhere  between and within this spectrum, and the results of treatment therefore, as well. And treatment is usually a two-way street: an unwriteable contract between care-giver, and care-receiver. Both need to trust each other; both need to respect each other or it won’t work. There are just too many variables.

Let’s return to the original question, however. What if, after waiting for three months or more to see the specialist, you find you do not like him? Well, I suppose in our system, you could refuse to go back to him and request a second opinion. There may be a delay in finding another doctor, and there is always the chance you might not like her either, but at least there is a choice, an option… For you…

But what about the specialist? What should I do if a person has been waiting to see me for several months and I have trouble relating to her? Not because of her race, or creed or sexual orientation; and certainly not because she comes into the office poorly dressed, or seems preoccupied with something else… These things to me are irrelevant. A medical practice is like a UN membership: toleration and respect for differences is part of the relationship, part of the expectation. I do not need to become friends with those that have been sent to me, although I don’t preclude it. And while I hope that my diagnosis of their problem will be accepted or at least considered helpful, I don’t demand to have the final say in their ultimate treatment if they don’t wish it. But there is a core expectation on my part that is integral to my continuing role in their health: not necessarily that I should like the person, but rather that I must not dislike her -not what she stands for, not what she may profess to believe, nor even who, in fact, she is -but her!

There’s a difference, isn’t there? We don’t all get along, but if we do, things flow more smoothly. There can be a give and take of ideas, a path of mutual understanding: on my part, that I think I can help; on the patient’s part, that she agrees that I may very well be able to accomplish what she needs. It’s a mutual thing, and both must be present for the contractual obligations of the referral to be fulfilled.

Admittedly, if there is dislike on one side of the desk, it very likely extends to the other side as well. But that begs the question doesn’t it? The patient may be reluctant to ask for another opinion: there is often a discomfort in that; she may not know what to do or how to extricate herself from the situation. And it is difficult for me to suggest she see someone else as well -especially if it’s not evident that she feels similarly. But in her interest -and mine, to be sure- I feel it has to be done. Fortunately it is uncommon -rare, in fact. I can’t remember more than two or three occasions in all my years in practice where I felt it was essential for a successful outcome. But it is an important option, and one that I think the patient ultimately, if not immediately, understands and accepts. Deserves. A medical relationship should be a space -a room- that both agree to enter. It’s certainly a place where I live… Both of us should be comfortable in the same milieu.

As Jose Ortega y Gasset has written: I am I plus my surroundings and if I do not preserve the latter, I do not  preserve myself. Nor, I would add, the patient herself…

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