A recent study found that, compared with people from other cultures, Americans are less likely to report feeling a sense of obligation to be present for their friends. If that reflects a broader cultural shift, it raises an uncomfortable question: Is this same emphasis on personal autonomy and individual comfort seeping into health care? Are health care professionals increasingly opting out of their obligation to care for patients when the relationship becomes uncomfortable?
I experienced something recently that made me wonder. I went to a med spa for a service I had already paid for, only to be refused care because the provider was “not comfortable” with my communication style, specifically my lack of eye contact.
As a neurodivergent person, eye contact can be uncomfortable, even painful, for me, so I am selective about when I make eye contact. It had never occurred to me that this could become the basis for a health care provider deciding not to treat me. But perhaps, in an era increasingly defined by “me first,” I need to expect it.
What struck me most was the inversion of the traditional health care relationship. When I was in nursing school, we were taught about unconditional positive regard: the idea that patients are deserving of care regardless of whether we like them, agree with them, or approve of their behavior. We were taught that this obligation extends even to patients who have committed horrific crimes.
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As a nurse, I cannot refuse to care for a patient because they belong to a different religion, hold different political beliefs, or simply rub me the wrong way. Even when a patient is difficult, angry, insulting, or verbally abusive, my professional obligation to provide care does not simply disappear.
There are, of course, legitimate circumstances in which a health care professional cannot safely continue a patient relationship. Patients can threaten staff, engage in violence, repeatedly violate boundaries, or otherwise make continued treatment impossible. Health care workers are human beings, and we deserve protection from abuse. But there is a difference between protecting oneself from abuse and withdrawing care because a patient makes one uncomfortable.
I’m sad to say that the med spa was not the first time I have experienced a provider effectively reneging on their side of the professional relationship. A primary care provider once threatened to discharge me from her practice after an episode of anxiety. A chiropractor dismissed me after I expressed frustration about having to wait an inordinate amount of time.
In both situations, my attempts to advocate for myself were interpreted as hostility. And, ultimately, the providers did not like what I had to say. Yet I needed them for care.
That is the part that troubles me. Patients enter health care relationships from a position of vulnerability. We need our providers. We may need their expertise, their prescriptions, their procedures, their documentation, or simply their willingness to listen to us. The professional relationship therefore carries an inherent power imbalance.
When a provider says, “I’m not comfortable,” what exactly does that mean? Is the patient behaving in a way that genuinely threatens the provider’s safety? Or is the provider simply uncomfortable with a patient who communicates differently, asks difficult questions, expresses frustration, or does not conform to expectations about how a patient should behave?
If it is the latter, have we quietly replaced professional obligation with personal preference? I worry that we are moving toward a model of health care in which both sides of the relationship are increasingly encouraged to ask, “What works for me?” rather than, “What does my role require of me?”
Patients certainly have responsibilities. We should treat health care workers with respect. We should follow reasonable rules and boundaries. Providers should not be expected to tolerate abuse.
But health care is not simply a collection of voluntary social relationships. It is a profession built around obligations.
A provider does not have to like every patient. A patient does not have to like every provider. And neither side should be expected to surrender reasonable boundaries. But somewhere between personal comfort and professional responsibility, there has to be a line. I fear we are beginning to draw that line in the wrong place.
If a neurodivergent patient’s lack of eye contact is enough to justify withdrawing care, what comes next? A patient who asks too many questions? A patient who is anxious? A patient who challenges a provider? A patient whose personality is simply difficult to like?
At what point does “I’m not comfortable” become a socially acceptable way of saying, “I don’t want to deal with this patient”? And if health care professionals can simply opt out whenever the relationship becomes uncomfortable, what happens to the patients who have nowhere else to go?
Perhaps the most important question is not whether health care workers should have boundaries. It is whether, in our increasingly individualistic culture, we are forgetting that professionalism sometimes means doing our job even when doing our job is uncomfortable.
Natalia Eden is a nurse.
