As healthcare providers, we see many types of people.  With each encounter, we want to establish rapport and build a relationship that will allow intimate and sometimes difficult conversations and will help our patient trust us enough to share their concerns and follow our recommendations.  And lets’ face it, we all want to be liked.  So when a patient tells us how much they love us, how they cannot live without us, that we are so much better than any other doctor, we should feel happy, right?

That’s exactly when we want to start backpedaling as fast as we can.

People who idealize us are telling us they need to believe we’re perfect.  But each of us has both strengths and weaknesses.  Inevitably, these patients will encounter one of those weaknesses – or they’ll want us to do something in a certain way, and we won’t meet their expectations.  When that happens, we immediately begin a rapid and painful fall off the pedestal they put us on.  When I first began practicing medicine, I believed it was my duty to treat everyone who came to me for help.  As a result, I’ve had plenty of experience falling off pedestals.

Several weeks ago, I walked into a patient’s room and was met with a look of adoration from a woman I had never met before.  “I’ve heard so much about you. I know you’ll be able to figure out what’s wrong with me.  None of the other doctors I’ve seen have been able to do that,” she said as she beamed up at me. In my early years, I might have been flattered.  “Wow, I guess people have noticed I’m a good doctor,” I would have thought with excitement.  After 30 years of caring for patients, I knew instead I was in trouble.

After listening carefully and reviewing her exam with her, I explained clearly that I had no better idea what was going on than all the other doctors she had seen, that I had no new suggestions for how to treat her, and that I didn’t think I would be able to help her (all of which was true).  Much better to disappoint her from the beginning than to promise to be a person I’m not, leading her to become angry and toss me off the pedestal she had placed me on.  If for some reason I do need to treat this type of person, I always under-promise.  I emphasize all the potential complications and spend time discussing the mysteries of science, the inexactness of medicine, and our inability to predict the outcome of any treatment.  With patients like this, it’s also a good idea to have a witness in the room and confirm that the patient has heard you clearly.

As healthcare providers, we invest a great deal of time, money, effort and concern in caring for our patients.  Given the emotional energy an unrealistic, demanding patient can cost us, for the sake of our own sanity and in service of the many patients who depend on us, it’s important to choose our patients wisely.  There are many appropriate places for us – in the exam room, the operating room, the conference hall – but not on a pedestal.