Wave of Consciousness, "A Voice of Sanity in a World of Conflict"

When You Don't Like a Patient

by Natalia J. Garland, M.S.W.

One of my favorite movies about alcoholism is The Verdict, which was produced back in 1982. It starred Paul Newman, James Mason, and Jack Warden. Newman was nominated for Best Actor for his portrayal of the film's leading character, an alcoholic lawyer named Jack Galvin. The movie was nominated for Best Picture. The story was based on the novel, Verdict, written by Barry Reed who recently died this year. Reed was a lawyer who specialized in medical malpractice cases.

When I read about Reed's death, I decided to check out a copy of the novel at the local library. Although I own the video and enjoy watching it from time to time, I had never read the novel. In the book and in the movie, the story follows the same basic plot: an alcoholic lawyer with a failing career takes on a seemingly impossible malpractice suit against a large hospital. The story is filled with the gathering of evidence to build a substantial case, courtroom drama, personal struggle, and a look at the unpleasant sides of the legal and medical professions.

I discovered, however, one great difference between the movie and the book. In the movie, Frank Galvin is a likable character. It is easy to cheer him on as an everyman hero who fights for what is right. In the book, Galvin is a womanizer, has an attitude problem, is very maladjusted and capable of rage, and quite unlikable. I would not have continued reading the book had I not been determined to compare it to the movie. I cannot imagine why an author would bother to write a novel in which the main character is, well, a jerk. I like to like my heroes.

The unlikable Galvin prompted me to think about people in general, and patients in particular, who are unlikable. I have had maybe three patients in my lifetime whom I simply did not like. I still remember the first such patient that I encountered, and how deeply it troubled me that I honestly did not like him.

Is it possible to like everyone? Are there not some people who just have very unlikable qualities? When I talk about not liking someone, I am not talking about personal whim. I am talking about people who are so negative and so disagreeable that they really do not show any appreciable behaviors or tendencies. But what happens when one of these unlikable individuals becomes your patient? How do you cope? Is it ethical to treat someone whom you do not like? How does that affect the patient/therapist relationship?

I believe it is possible to provide fair and good treatment to the unlikable patient. It is a matter of professionalism. The same social work skills and knowledge can be applied to the likable as well as to the unlikable. It may feel somewhat strange for the therapist, and such a case may be less rewarding, but the course of therapy can proceed to a successful termination point.

If you read Reed's novel to the end, you will be glad you did. The hero, Frank Galvin, skillfully communicates with the jury. In his summation he says, "It boils down to this: What is the value of human life? What is a good life worth? Again, this is for you alone to decide. In many countries human life is the cheapest commodity available. You know, in 1937 Amelia Earhart was missing with Fred Noonan out over the Pacific. Our government spent thirty million dollars trying to find her: search planes, patrol ships, men, manpower, day in, day out. It wasn't until Pearl Harbor Day, 1941, that we officially called off the search."

Perhaps that is also why mental health professionals can treat the unlikable. The value of human life is recognized. The need for help is just as legitimate. The right to receive quality services is just as important. The unlikable patient can be just as proud of his goal accomplishments as the likable. And we can be proud of ourselves that we helped lead such a person to a greater fulfillment of his humanity. (Written 10/07/02)