Sometimes I just don't want to smile. The expectation that we are supposed to act cheerful for every patient as if we're on some sort of beauty pageant competition is not realistic. Doctors can have bad days too. Most of the time it has nothing to do with the patient. Maybe I didn't have a chance to grab a cup of coffee this morning. Perhaps I had a fight with the surgeon on the previous case. I might have had an argument with my spouse the night before that has led me to this state of anger. I may be just tired from taking too many calls this month. So you see, it's not always personal.
But occasionally it is. If a patient acts confrontationally as soon as I utter "Hi" then my mood can change faster than Bin Laden's capture by Seal Team 6. What is confrontational? How about "I'm only going to give you one chance to start my IV" Or if the patient says, "I need to have this and this and that drug after the surgery. Nothing else will work for me." Many times it is the patient who is okay but the family who can be difficult to handle. A mob of immediate family members may cluster around the bed with each person asking questions about what drugs I'm going to use, how many years I've been working, where I did my training, etc. all in the name of "protecting" the patient. In situations like that you will not see a single tooth of a smile from this grim visage.
I know patients' expectations are for the kindly, caring, quiet, paternalistic doctor they see on TV. It can be quite a shock to realize that doctors are human too. We try hard to be nice. Like any job in the service sector where achieving great customer satisfaction is the key to a successful business, we attempt to give every patient a smile and a job well done. But as anyone who has every had a bad experience at the Post Office, or the DMV, or McDonald's can tell you, everybody's going to have an off day now and then. Hopefully it is not common. If it is a frequent occurrence, perhaps it is time for a vacation or a new job. Being a medical doctor I can't really change into a new job easily. But goodness I feel a need for a vacation right now.