"In Sickness and In Health Till Death Do Us Part": Is This What We Ask of Our Doctors?

My threads on patients hating doctors have stirred a lot of conversation here. I am still trying to understand fully the explanations patients give as the reasons for that hate. After reading the article "A Sentimental Patient" by John Portmann in the Cambridge Quarterly of Healthcare Ethics (2000, 9, 17-22), I wonder if sentimentality is one such mechanism. Portmann defines sentimental, in the sense of the doctor-patient relationship, as "a contrived exaggeration of emotional availablility of physicians." What this means is that the patient expect more emotional and concerned feedback from the physician than what is realistic. Portmann, however, says that sentimental patients are not hateful, however they may experience the same issue: attempting to deal with their concept of an "ideal doctor" vs the doctor's response which is likely based the realities of what is facing the physician trying to care for "sick and troubled" patients. I, myself, wonder nevertheless, whether sentimentality is not a major cause for the feeling and expression of hate for one's physician or physicians in general.

It is understandable that some patients may need sentimentality if their own emotional needs are unmet and especially so during times of illness and discomfort.
They would want their doctor to be more interested in them, more comforting to them and provide them with something more than a cold and casual paper prescription, if even that. When their doctors don't meet their expectations, the patient will look at their physician as heartless and anything that the doctor accomplishes to the benefit of the patient will appear incomplete and anything not accomplished will appear what the patient expected. Portmann writes "Belief in caring generosity of physicians falsifies what we know about them by emphasizing their virtues and underplaying their other committments and motivations."

The question is whether the establishment of the doctor-patient relationship actually, to some patients, represent almost a marriage vow in terms of what medical ethicists (Quill and Cassell, 1995) by their definition of the doctor-patient relationship as "a covenantal relationship grounded in mutual respect and caring... [including]caring, fidelity, altruism and devotion...[and] the particular importance of long-term, engaged presence... [and] the promise to face the future together."

If all this is what some patients expect from their doctor beyond skill and technical knowlege and willingness to listen, try to understand and try to provide supportive empathy, then I can see displeasure and even hate if the doctor doesn't provide more.

What do you think is the role of sentimentality on the part of the patient and it's role in the expressed hate? Do you think patients expect more emotional concern or involvement by their doctor, perhaps almost in a family way, than they usually receive? ..Maurice.