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Dr. Leonard’s competancy as a physician and neurologist have never been in question. Phil is a fine Doctor and a well respected and highly competent Neurologist. I have referred patients to him and would continue to do so. This entire incident is a source of concern to me, since it highlights problems with physician/patient relationships, transference/counter-transference, and errors in interpersonal nonverbal communication.

The physician’s office is an intimate environment. Patients completely expose themselves physically as well as emotionally; this creates a type of intimate relationship between physician and patient which we, as physicians are careful to not abuse. However, with some patients, an emotional and intimate attachment evolves as a result of this nakedness. The patient experiences transference and sometimes the physician (unwillingly and unknowingly) responds through counter-transference. When this happens, the patient can perceive the physician response as a type of (non-existing) physical intimacy.

Add to this the non-verbal body language in a transference-counter transference situation and you have the recipe for trouble. Patients perceive our caring for them (physically) as caring for them (emotionally). I don’t think we should stop caring for them, but how to get patients to make this distinction is difficult. It is a thorny patch.

David Wishnew