Patients need doctors. Doctors need patients. There is, in fact, a two-way relationship between the two groups. The more obvious aspect is the fact that patients need doctors. Patients need doctors to diagnose, advise, prescribe and reassure. There are other facets of this aspect of the patient-doctor dynamic, of course.
Perhaps more interestingly is the recognition that doctors need patients. Firstly, we need patients to give us a purpose. I would not be a GP unless there were patients needing a general medical service in the area. Without the need there is simply no job, without the demand there is no need to offer and be paid for a supply. The job in itself, also offers satisfaction and fulfilment as one can feel that a difference is being made, however small, and that the world might be made a better place as a result of the work that we do. I would argue that patients give us that feedback verbally, non-verbally, consciously and unconsciously by trusting us with their secrets, hopes and fears.
Issues arise, however when doctors, for whatever reason, develop a psychological dependence on being needed and liked by their patients. This may be due to lack of meaning or fulfilment in other aspects of their life, or because of underlying psychological issues. The consequences of this can be damaging both to the healthcare system as a whole and to both the patient and doctor. What happens is that doctors make decisions in order to please their patients, not because of what is correct, leading to inappropriate treatments, investigations and referrals.
In an ideal world, however, the dynamic relationship between a doctor and his patient is symbiotic. Many GPs work with the same group of patients for many years and so this relationship can be long lasting. The doctor gives the patient what he/she needs and the patient, usually unknowingly reciprocates.
As with an overly needy doctor, the patient too can upset the dynamic when they are parasitic, sucking the lifeblood out of the doctor, constantly drawing upon the doctor to make them feel better. I would also hazard a guess that most of these types of patients would have psychological pathologies that some would categorise as personality disorders. As doctors we have all met patients who have manipulated our emotions to make us feel bad and themselves a little better.
It is important, therefore, to recognise that one (or one’s colleagues) can fall into the trap of wanting too much to be liked by patients. Furthermore, a number of patients are emotionally parasitic, and need dealing with as we would deal with any parasite; we need to protect ourselves from them and even consider treating and/or distancing ourselves to ensure that we don’t become infested by their life-sucking behaviour.