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\subsubsection{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 misperception  that occur occurs  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 do not 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.  Patient anxiety and cognitive confusion when ill may make it impossible for the patient to ask for the 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 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 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 (Christakis 1997). \cite{(Christakis1997}.  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  \subsubsection{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.  The brevity of contact makes procedures "medi-centric" rather than focused upon the patient's needs and desires. Efficiency, such as rapid discharge or referral, may be valued over benefit to the patient. Medical care teams who do not know each other well enough to trust each other may rely on authority or "turf" to enforce their wishes to the detriment of patient care. Psychosocial problems may be dumped on another team or service. Intimacy is avoided. Commitment, even to medical tasks, may be avoided due to the small amount of time spent on a service or with a patient.  Allsop, Judith and Linda Mulcahy (1999), Doctors responses to patient complaints., in Rosenthal, Marilynn, Linda Mulcahy, and Sally Lloyd-Bostock (eds.), (Medical Mishaps, Buckingham, UK: Open University Press),