Doctor-patient interaction: in response to Foxy's question

Thank you, Foxy, for your comments and question. You have just touched upon an important but overlooked issue in physician-patient relationship. You astutely observe that some doctors can be nervous and defensive when they are seeing patients with rare diseases (including PHEOCHROMOCYTOMA) that they know little about. There is no simple solution to the problem but I can provide some background here so that we can think of creative ways to solve the problem.


Physicians are used to be viewed as knowledgeable experts. They are supposed to help patients, to guide, and to cure. Many physicians also have a large ego as well and enjoy the role of a healer and its associated prestige. When they see a patient who suffers from a disease they know almost nothing, all the pretext of their psyche suddenly does not exist any more. A good number of physicians take this as an opportunity to learn with the patient and acknowledge their ignorance and willingness to learn, while some others will act out and use defensiveness to hide their embarrassment.

Although I don't think patients are to blamed for the problem, patients are indeed also part of the issue. Patients sometimes unknowingly encourage bad physician behaviors. For example, some patients may take arrogance as confidence of a physician. Some patients like black-and-white decisions and take discussion of nuances as indecisiveness of a physician.

At the end of the day, I guess the physician-patient relationship is like any other relationships--you relate with the one you like, and you separate from the one you dislike, and face the consequences.


Finding a good physician should aim at different goals at different disease stages. For definitive diagnosis, you need an expert on pheochromocytoma even though the expert may not be a perfect lady/gentleman. For surgical resection, you need an expert surgeon who has many cases before yours. For follow up, the character of the doctor is more important than knowledge and above all, you may not have a local expert in the first place.

As many of my own patients are from out-of-town, they often ask me how to pick a local doctor to coordinate the care for pheochromocytoma. The advice I give to my own patients is the follows: 1) you trust and like the doctor, 2) the doctor has an open mind on diseases she/he is not familiar with. The specialty of the doctor is not so important.


Let's not even start mentioning the hurdles on choosing physicians placed by HMO, the insurances, and other societal beings.

Dr. Pheo