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\subsubsection{ “A Physician Loses Her Cool”} 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 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.”  A year later Discussion:  When an ongoing relationship exists between  the physician returned apprehensively for a second examination. She planned in her mind doctor and patient an opportunity exists  to discuss repair mistakes and faulty communication. Faced  with the radiologist how difficult possibility of malignancy, or in other crisis situations neither  the earlier encounter has been. She went over patient, nor the doctor may be in optimal shape to clearly communicate their questions, doubts  and over what she would say 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 she had felt they are doing, why they are doing it,  and how frightening what  the patient’s  experience had been.  When will be like.  Patient anxiety and cognitive confusion when ill may make it impossible for  the radiologist came in she began patient  to speak before ask for  the doctor-patient could say information or reassurance they need. The physician needs to develop standard psychological procedures for dealing with this anxiety or confusion and to constantly review these procedures for their adequacy. A patient who is unhappy with  a word: “How are you? I have been wondering procedure gives the doctor a signal that indicates they may not be preparing patients adequately.  Lastly physicians should be aware of the psychological phenomena of identification and  how you have been. I have thought so it may affect their treatment of patients for good or ill. In this case example the doctor identified with a patient who was very  muchabout you and your illness. You are young  like me her. However this led to the doctor becoming anxious to do an exceptional job  and I identified so strongly hyper-professional in her attempt to both do something and conceal her anxiety. When the physician becomes aware  with your situation hindsight  that I behaved badly, I wanted such an error has been made a phone call or letter  todo  the best study we possibly could patient might well be appropriate. When the patient is aware of nagging questions or unresolved anger they also might consider contacting the physician in an attempt  to help you. work out the problem.  I felt so badly afterward about what believe the economic pressures of managed care are forcing physicians to see patients for too short a time and too close together.  I said.”  end{subsection} 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.\cite{Christakis_1997}  \subsubsection{Discussion:} 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. Exemplar  When an ongoing relationship exists between the doctor and patient an opportunity exists to repair mistakes and faulty communication. Faced with the possibility Christakis, D.A., Feudtner, C. (1997), 'Temporary matters: The ethical consequences  of malignancy, or transient social relationships  in other crisis situations neither medical training.', Journal of  the patient, nor American Medical Association, 278 739-43.  An excellent article on  the doctor may be in optimal shape to clearly communicate their questions, doubts and explanations. Return visits conflict between the need  and follow-ups, even with consultants, may desire for the physician to  be invaluable in correcting mistakes efficient  and perceptions the demands on time  thatoccurs in brief, stressful, or emergency encounters.  Doctors and patients  are faced with conflict between their wishes required  for personal contact human social relationships with patients, colleagues, medical teams  and demands family. The adverse effects on current medical practice, particularly in tertiary teaching hospitals, are noted.   The brevity  of professional responsibility. Patients want to get to know their doctors so they can build faith and trust. This is true even if contact makes procedures "medi-centric" rather than focused upon  the encounter is a “technical” one patient's needs and desires. Efficiency, such  as it was in this example. Patients rapid discharge or referral, may be valued over benefit to the patient. Medical care teams who  do not want some “Bozo” doing a biopsy of their kidney, or putting a large tube down their gullet know each other well enough to trust each other may rely on authority  or up "turf" to enforce  their rear end. It is important for physicians wishes  totake  the time whenever this detriment of patient care. Psychosocial problems may be dumped on another team or service. Intimacy  is humanly possible avoided. Commitment, even  to explain what they are doing, why they are doing it, and what the patient’s experience will be like.  Patient anxiety and cognitive confusion when ill medical tasks,  may make it impossible for the patient be avoided due  toask for  the information or reassurance they need. The physician needs to develop standard psychological procedures for dealing with this anxiety small amount of time spent on a service  orconfusion and to constantly review these procedures for their adequacy. A patient who is unhappy  with a procedure gives the doctor a signal that indicates they may not be preparing patients adequately.\cite{Cassell_1997} patient.  Lastly physicians should be aware of the psychological phenomena of identification and how it may affect their treatment of patients for good or ill. In this case example the doctor identified with a patient who was very much like her. However this led to the doctor becoming anxious to do an exceptional job and hyper-professional in her attempt to both do something and conceal her anxiety. When the physician becomes aware with hindsight that such an error has been made a phone call or letter to the patient might well be appropriate. When the patient is aware of nagging questions or unresolved anger they also might consider contacting the physician in an attempt to work out the problem. This is an example of a useful slip or mistake that caused the doctor to reflect on her own behavior. The reflection is useful in correcting the mistake and her professional manner, not only with this patient but others in the future.   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 \cite{9286834}.  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  s),