The New Yorker:

In 1978, James Groves, a psychiatrist at Massachusetts General Hospital, published a now classic paper in the New England Journal of Medicine titled “Taking Care of the Hateful Patient.” In it, Groves acknowledged a truth widely, if quietly, known among medical professionals—that some patients are true nightmares. Groves wasn’t referring to the common jerks and complainers. “The fact remains that a few patients kindle aversion, fear, despair or even downright malice in their doctors,” he wrote. He cited the example of an attorney with multiple sclerosis who harangued his doctors and threatened to sue the previous “bastard” who had tried to help him: “He was like Job, who raged, ‘Ye are forgers of lies, ye are all physicians of no value.’ ”

Groves divided these dreaded people into four categories. The “clingers” were “overt in their neediness,” requiring constant explanations, affection, and attention. Even absent any actual ailment, they demonstrated a “self-perception of bottomless need” and saw their physicians as “inexhaustible.” At least they showed gratitude, though, unlike the “manipulative help-rejectors” (a.k.a “crocks”), who constantly replaced one symptom with another and were never more self-satisfied than when the doctor’s diagnosis was wrong. The “self-destructive deniers,” meanwhile, ignored medical advice in a different way; they were the hepatitis patients who still drank heavily, the guys with heart disease who kept “forgetting” their physicians’ warnings not to shovel snow. And then there were the “entitled demanders,” who used “intimidation, devaluation and guilt-induction to place the doctor in the role of the inexhaustible supply depot.” They were like the clingers, but hostile. “The patient may try to control the physician by withholding payment or threatening litigation,” Groves wrote. “Such patients often exude a repulsive sense of innate deservedness as if they were far superior to the physician.”

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