Masks for the Medical Encounter: When the Encounter Hurts Everyone

There is a particular kind of silence that hangs in the air after a bad consultation. It is not the same as simple fatigue. It is denser, heavier, harder to name. The doctor feels it walking back to the desk. The patient feels it walking down the corridor. The administrator feels it when the complaint arrives on their screen a week later. Nothing exploded. No one was hit. And yet something in that small room has just made everyone’s life more difficult.

If we are honest, most of us in medicine know that silence well.

From the doctor’s side, it often begins long before the encounter that finally “goes wrong”. It begins with a slow accumulation of small frustrations: the patient who does not follow advice, the same story repeated for the tenth time, the feeling of being pressed to fix problems that come from far outside the clinic walls, the sense that every word may later be used in a complaint. At first the irritation is fleeting, then it lingers, and eventually it starts to show. A sharper tone here, a shorter explanation there, a visible sigh, an involuntary tightening of the jaw. Most patients pass over these small signs without comment. Some do not. 

From the patient’s side, the story is different but parallel. Many people arrive in the room already wounded by previous experiences: the time they were not believed, the test that was never explained, the rushed dismissal of a symptom that later turned out to be serious. They come in carrying fear, disappointment, and the quietly humiliating sense of needing permission to speak about their own body. They wait in a crowded corridor, rehearse their questions in their head, and then discover that the doctor seems hurried, distant, or even slightly irritated before they have finished their first sentence. It does not take much for them to feel that this encounter, too, is unsafe.

From the organizer’s side, the same scene appears again with yet another layer: the clinic is full, the schedule is overbooked, the staffing is thin, the targets are rigid, and the number of complaints is slowly rising. When an angry letter arrives naming a specific doctor or a specific visit, someone in an office must decide what to do with it. Was this a matter of misunderstanding, of patient expectation, of clinician behavior, of systemic overload — or all of the above? Each complaint becomes one more data point in a growing picture of relational strain.

It is tempting, from each position, to simplify the story.

From the doctor’s chair, the difficult encounter is “because of” the patient — demanding, non‑compliant, manipulative, unrealistic. From the patient’s chair, it is “because of” the doctor — cold, arrogant, inattentive, burned out. From the organizer’s office, it is “because of” one or both of them — the impatient patient, the unprofessional clinician — and the implicit hope is that a stern conversation, a warning, or a transfer will fix the problem. 

Sometimes there really is bad behavior. There are patients who cross lines, doctors who should not be in practice, leaders who misuse power. But if we stop the analysis there, we miss the more common and more dangerous pattern: the encounter that hurts everyone not because any one person is monstrous, but because the form of the meeting is poor and no one inside it has enough protection.

In this chapter, we will stay close to the lived experience of such encounters, before we offer any solutions. Our aim is to make visible what too often remains unnamed: that the medical encounter can fail as an encounter even when nothing dramatic happens medically. A prescription is written, a test is ordered, a box is ticked — and yet both doctor and patient leave feeling smaller, not larger; more defensive, not more connected; more convinced that “the system” is against them.

Let us listen more closely from each position.

From the doctor’s chair

From the doctor’s side, the hurt often begins as a mismatch between inner and outer reality. On the outside, the doctor is supposed to be calm, focused, endlessly attentive. On the inside, there may be fatigue, time pressure, personal grief, or simple human limitation. The gap between the ideal role and the lived internal state grows wider with each consultation. The more this gap widens, the more easily small triggers — a raised voice, a repeated question, a skeptical look — pierce through the professional surface.

In this state, even neutral patient behavior can be experienced as attack. A request for a second opinion may feel like an insult. A question about a treatment plan may feel like distrust. A mention of online information may feel like a challenge. The doctor begins to brace for contact rather than look forward to it. The encounter becomes something to survive.

From the patient’s chair

From the patient’s side, the hurt often begins with being unseen. The patient may have waited weeks for this appointment, may have organized work, family, and transport around it, and may have rehearsed what to say many times. When they finally sit down and notice the doctor’s impatience, divided attention, or skepticism, they experience not only disappointment, but a kind of small humiliation. The sense is not just “I am not being helped”, but “I am not being taken seriously”.

For many, this is not the first time. Patients with chronic, complex, or poorly understood conditions can often recite a long list of encounters where they felt blamed, dismissed, or pathologized as personalities rather than listened to as people. Each new contact with the system carries the weight of all previous ones. In such a context, even minor signs of distance from the clinician can reopen old bruises. 

From the organizer’s office

From the organizer’s side, the hurt often shows up as numbers and narratives that do not match. On one side: performance dashboards, throughput statistics, waiting time reports, satisfaction scores. On the other: stories of staff burnout, patient anger, miscommunication, delays, and conflict. When a complaint arrives, it is rarely a clean, single issue. It is usually a messy mixture of relational frustration, structural constraint, and perceived injustice. 

Leaders in such systems are asked to do something that is almost impossible: maintain safety, quality, and efficiency while also caring for the psychological well‑being of staff and patients in environments that are already stretched. Under this pressure, it is easy for them to slip into their own defensive forms — controlling, avoiding, blaming, or minimizing. The encounter between clinician and patient is then nested inside a larger encounter between frontline and management, which can hurt just as much.

Why we start here

We begin this book not with masks, not with techniques, and not with solutions, but with this shared pain. If we do not take seriously how the medical encounter can hurt everyone involved, we will be tempted to use masks as mere decoration — as another layer of performance on top of an unchanged structure.

Our claim is simple: many of these hurts are not inevitable. They are not built into the fact that people are ill, that resources are finite, or that mistakes happen. They arise in large part from the way the encounter is presently shaped — from roles that are unclear or too rigid, from boundaries that are either too weak or too hard, from expectations that are never spoken and never aligned. 

In the chapters that follow, we will argue that part of the remedy lies in becoming more deliberate about the forms we bring into the room. But before we can change those forms, we have to see the damage that the current ones are doing. When an encounter hurts everyone, it is not a private failure or a personal shame. It is a signal that the way we are meeting one another in medicine is no longer adequate to the lives we are trying to live and the work we are trying to do.

Our claim in this book is not that we can remove pain, uncertainty, or scarcity from medicine. We cannot. What we can change is the way we meet one another inside those realities. When an encounter hurts everyone, it is a message from the system that the forms we are using are no longer good enough. The rest of this book is our attempt to answer that message.

You can learn more by reading our e-book 

Mykola Iabluchanskyi together with Andriy Yabluchanskiy