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reading books that proposed alternative approaches to autoimmune diseases. Ultimately, when the lupus did not improve, she decided to pursue mainstream remedies, including drugs with significant side effects. She sought second opinions and felt that she had a clear view of her options. Equally important, Lisa felt that her rheumatologist understood her mind-set. “He knew where I was coming from, that I hated those drugs and wanted to come off them as soon as possible,” she said. In essence, the doctor molded his approach to fit Lisa’s, trying repeatedly to decrease the amount of medication she took, only to find that her lupus flared when she was prescribed the lower doses. It took several years before she went into remission, but despite her frustration with what she termed a “roller-coaster ride” of diminished doses followed by intensive treatment, with all the side effects of insomnia, voracious appetite, and swollen body parts, she never regretted the decisions she’d made along the way. With her lupus, she followed her “normal” process. But with her foot surgery, Lisa realized that she had abandoned it.

Before her trip to Europe, she felt she’d entered into a “negotiation” with the doctor. It was a different type of negotiation from the one Dr. Carter told us he conducts with his patients, where he explores what a person wants or doesn’t want and why. “The doctor agreed to give me the cortisone injection so long as I scheduled the surgery for the week I returned,” Lisa told us. She felt that if she changed her mind, she would be backing out of a promise she had made. “I really don’t know why I let myself be boxed in,” she said. “I felt I sort of owed him something in the way we had agreed to go forward.”

Many patients have such feelings and don’t want to disappoint their doctors. Psychologist Judith Hall at Northeastern University and health researcher Debra Roter at Johns Hopkins have extensively studied physician-patient interactions. They focused on the emotions that patients often feel in what is typically a power imbalance—the doctor is an authority figure with special knowledge and skill, the patient needs expert assistance to remedy a problem. Many patients fear appearing “difficult,” worried that they will alienate the doctor by questioning his thinking and challenging his advice. One patient we spoke with who was contemplating hip surgery even worried that his pointed questions could cause his doctor to do a less than excellent job for him, “subconsciously taking his annoyance out on me.” This scenario prevented the patient from discussing his concerns candidly with his doctor, even though there was no indication the physician was anything less than professional. Moreover, when a physician expresses disapproval or dislike of a patient’s thinking or feelings, Hall and Roter found, the patient often blames herself, imagining the doctor’s judgment pinpoints a flaw in the patient’s character. “I didn’t want to be a curmudgeon type of patient,” Lisa told us. “And I can be that way, resisting what the doctor recommends.”

So, she explained, “I was afraid to confront the doctor one-on-one. I think I wanted someone else to tell him about my concerns.” The nurse and her school principal had rightly advised Lisa to tell the doctor herself. “I was being a total chicken about it. I just didn’t want to deal directly with him.”

Even a strong-minded and well-informed person like Lisa may find it difficult to exercise her usual degree of autonomy when she’s ill. We spoke with a renowned professor of English at a prestigious university who is used to prevailing in faculty debates and in negotiations with the college president. He fractured his leg and underwent a series of risky operations. “Each time I sat with the surgeon, it was as if my mind went out the window,” the professor told us. “I was like a frightened child in front of him and couldn’t think at all.”

When considering an important medical decision, patients are often advised to obtain a second opinion. Lisa sought a second opinion from another prominent orthopedic