To the Editor: Patient arrogance definitely does exist and can complicate the process, described by Ellard, of “diagnosis, prognosis and therapeutics”.1

I believe this state of affairs has arisen for two reasons. Firstly, from the evolution of “informed consent” linked to “patients’ rights” — principles that need no elucidation. Secondly, as a consequence of the explosion of media and technology. Television has given us a surge of medical programs, especially of the so-called “reality” type, and technology has made information easily available on the Internet.

Unfortunately, patients become Internet surfers and surfers become patients. When they then present with symptoms, it is often armed with some knowledge — albeit of dubious quality and veracity. If the doctor does not provide a very accepting ear to these proffered “medical data”, the patient often stops listening, becomes intransigent, and tends to prefer the media- or technology-generated opinion, including the suggested treatment for the semi-self-diagnosed disorder or illness.

I am reminded of one of Groves’ subtypes of “hateful patients”, namely “entitled demanders”. He wrote, “. . . they use intimidation, devaluation and guilt induction. . . . The patient may try to control the physician. . . . Such patients often exude a repulsive sense of innate deservedness as if they were far superior to the physician.”2

In my own practice, I had one such patient who would arrive and immediately intimidate my secretary by literally throwing his Medicare card on the desk in front of her and ordering her to turn off the radio that was tuned quietly to ABC FM. She has now retired, but, even 2 years later, says she will always remember him!

It takes considerable tact and skill to deflect and reduce the hostility of an arrogant patient so that he or she can ultimately benefit from the consultation. Perhaps it is best done by keeping in mind the fundamental principle primum non nocere.