Changing patient attitudes and physician self-esteem may be on a collision course. I was reading an old study from 1988 that found that the patients who are most troubling to doctors are those who pose a threat to the physician’s sense of professional integrity. Patients who are disrespectful, critical or demeaning are far more irritating than those who disregard the doctor’s instructions or who cannot pay their bills, the study found. They also found that patients who provoke an emotional reaction in their physicians may unwittingly interfere with the physicians diagnostic accuracy and treatment decisions. They write. “If a doctor’s self esteem relies too much on his professional self-image, he’ll be vulnerable to patients who seem rejecting in some way.