Those who express warmth toward you are not necessarily fond of you. Those who express hostility are not necessarily angry at you.
Patients quite often use their emotions as shields against underlying feelings with which they cannot deal directly.
It is far easier to be oily sweet toward someone when you feel that they may abandon you. You cannot risk expressing your resentment because you are concerned that the individual will then have justification to desert.
Conversely, some, but certainly not all, openly hostile patients are not angry with you at all. They are painfully fearful.
Perhaps no one as yet has found the underlying cause of their physical symptoms. Their care is spanning many months with no end in sight. They are undergoing painful procedures which they feel are not productive. They are having to verbally bargain to get their medications refilled. They are losing material holdings such as a vehicle or their home and are increasingly alarmed at what will become of their lives.
Their families are critical of them and express open anger toward them for their nonproductivity. They feel guilty because family needs are not being met. They believe that ultimately you, their physicians and certainly their families will soon tire of them.
Recently a patient told me that he was aware that he was a “burden to the system” and that ultimately “they are going to get tired of trying to find out what is wrong and simply cut on me; I know they are very frustrated that I do not improve.”
There is nothing pleasant about a patient who is rude, accusatory, sarcastic and/or dismissive, but it is important to realize that in some cases, this is not anger, but fear, that is driving the emotion.
And, of course, keep in mind that one of the earliest signs of clinical depression is such increased irritability.