It may also be the case that what for one of us is challenging is for another disruptive. I have had a few patients who literally no one else in town would see whom I kind of got to like after some fairly difficult encounters. One had been forcibly removed from the VA clinic by security, and they have a pretty broad acceptance policy. There are others I just could not stand that another colleague found fairly pleasant. I have one very bright patient with his professor spouse who both take copious notes on legal pads, research every issue exhaustively using real studies (not just internet hooey), and took several minutes once to correct me when I referred to one study as a "metaanalysis" when it was more properly a review of the literature as it did not possess the correct statistical format. It took some getting used to, but now is really quite an educational experience, as long as my staff knows that there is no such thing as a brief visit when scheduling. Obviously, there is no amount of money that will ever reimburse us for this stuff. Some things are done because they just have to be done, and some can be perversely enjoyed.
