Hateful Patients

In a 1978 article in the New England Journal of Medicine, Massachusetts General Hospital psychiatrist James E. Groves categorized the patients “whom most physicians dread”:

“Dependent clingers” escalate from normal requests for reassurance to “repeated, perfervid, incarcerating cries for explanation, affection, analgesics, sedatives and all forms of attention imaginable.” They may have severe, even life-threatening disorders, or they may have no discernible illness at all.

“Entitled demanders” use “intimidation, devaluation and guilt-induction to place the doctor in the role of the inexhaustible supply depot.” They may even try to control the doctor by withholding payment or threatening to sue.

“Manipulative help-rejecters” appear almost smugly satisfied, returning “again and again to the office or clinic to report that, once again, the regimen did not work.” When one symptom is relieved, another appears in its place.

“Self-destructive deniers” show “unconsciously self-murderous behaviors, such as the continued drinking of a patient with esophageal varices and hepatic failure.” These patients “seem to glory in their own destruction. They appear to find their main pleasure in furiously defeating the physician’s attempts to preserve their lives.”

“Admitted or not, the fact remains that a few patients kindle aversion, fear, despair or even downright malice in their doctors,” Groves wrote, noting that the medical literature had largely failed to address this problem. “Emotional reactions to patients cannot simply be wished away, nor is it good medicine to pretend that they do not exist.”

(James E. Groves, “Taking Care of the Hateful Patient,” New England Journal of Medicine, April 20, 1978.)