Often people are mean or manipulative because they are afraid. Sick people should be extended grace, but unfortunately our system does not reward practitioners, especially doctors, for this. The patient-doctor relationship is not between peers—nor should it be. But if physicians could hold awareness that every patient is as worthy as they themselves are, the need for negative notes might well be reduced. There’s an exchange that happens beneath the spoken words, and a frightened patient may well respond to a condescending doctor with defensive hostility.