Regarding the Feb. 3 letter “It’s not all about the doctor,” which was in response to Dr. Katherine Schlaerth’s Feb. 2 column “Report card prescription has side effects”: The quotation from Thomas Mann has relevance in this discussion, i.e., “What Peter says about Paul tells us more about Peter than it does about Paul.”

To the extent Mann was correct, the letter writer may actually illustrate her and the columnist’s point by attacking it. It may have nothing to do with the columnist’s ego. But in “defense” of the letter writer, she has the Army Office of the Surgeon General — in regard to quality control — on her side, to say nothing of the Department of Defense, in regard to the various reports that supervisors make on those they supervise. Although the doctor used stereotypes to make her point in her column, common sense gives it a measure of validity. The danger is taking either extreme position, i.e., that patient’s opinion about their medical professionals means either everything or nothing.

What patients need to hear is often at odds with what they want to hear. So what does the “good and wise” professional say? The answer is not so complicated; it’s “what works.” Unless and until some solid trust has been established between the professional and the patient, the “truth” will be counterproductive.

Instead of pontificating, the professional would do well to use some gentle questioning about what the patient believes. This needn’t lead to an open disagreement, much less a lecture. However, the professional must be careful about letting the patient’s misguided beliefs dictate what the professional does or does not do, since that could be malpractice for which the professional is liable. Consider the case of Dr. Conrad Murray and his patient, Michael Jackson, as a possible — albeit extreme — example.

What about providing expensive care that is not harmful but not helpful? That is a significant factor in the high cost of medical care and the insurance to pay for it.

The point of Dr. Schlaerth’s column has to do with the “law of unintended consequences.” Giving patients a voice in the quality of their care has the potential of favoring the professionals, whose only concern is keeping patients happy with their care, and disfavoring those who may be more competent and more “professional,” i.e., concerned with what is best for the patient. To the extent that true professionals are driven out of the system, both the quality and quantity of care would be diminished.