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“A Physician Loses Her Cool”  A young physician with a prominent allergic history required a CAT scan for suspected malignancy. Because of her allergic history her internist advised against the use of contrast media. As she was lying on the X-ray table the radiologist, another young physician towered over her and castigated her for not allowing the use of contrast media. The patient felt frightened and humiliated, as well as powerless to defend the decision against using contrast media. After all it was not her decision but her doctor’s.  A year later the physician returned apprehensively for a second examination. She planned in her mind to discuss with the radiologist how difficult the earlier encounter has been. She went over and over what she would say to explain what she had felt and how frightening the experience had been.  When the radiologist came in she began to speak before the doctor-patient could say a word: “How are you? I have been wondering how you have been. I have thought so much about you and your illness. You are young like me and I identified so strongly with your situation that I behaved badly, I wanted to do the best study we possibly could to help you. I felt so badly afterward about what I said.”  Discussion:  When an ongoing relationship exists between the doctor and patient an opportunity exists to repair mistakes and faulty communication. Faced with the possibility of malignancy, or in other crisis situations neither the patient, nor the doctor may be in optimal shape to clearly communicate their questions, doubts and explanations. Return visits and follow-ups, even with consultants, may be invaluable in correcting mistakes and misperceptions that occur in brief, stressful, or emergency encounters.  Doctors and patients are faced with conflict between their wishes for personal contact and demands of professional responsibility. Patients want to get to know their doctors so they can build faith and trust. This is true even if the encounter is a “technical” one as it was in this example. Patients don’t want some “Bozo” doing a biopsy of their kidney, or putting a large tube down their gullet or up their rear end. It is important for physicians to take the time whenever this is humanly possible to explain what they are doing, why they are doing it, and what the patient’s experience will be like. 
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I believe the economic pressures of managed care are forcing physicians to see patients for too short a time and too close together. I do not believe adequate medical care can be  delivered on a production line. It is very legitimate for a patient to protest “I need more time to talk about this decision”. For optimal care both the physician and patient need time to talk and think (Christakis 1997).  Knowledge base: managed care, brief encounter, identification with patient, doctors in treatment, mindfulness, traumatic encounter, talking with patients, explanation of procedures, patient preferences, patient decision making, patients in acute crisis, patients with acute illness  References:  Christakis, D.A., Feudtner, C. (1997), 'Temporary matters: The ethical consequences of transient social relationships in medical training.', Journal of the American Medical Association, 278 739-43.  An excellent article on the conflict between the need and desire for the physician to be efficient and the demands on time that are required for human social relationships with patients, colleagues, medical teams and family. The adverse effects on current medical practice, particularly in tertiary teaching hospitals, are noted.