"I don't need you to come see me anymore," I said to my clinic patient. "I'm not the right doctor for you. You need to see a specialist."
"But I like seeing you."
"That's flattering, but I can't really help you as well as someone else is going to be able to."
"I don't want to start over with a new doctor."
"You need to be followed, more closely than I can follow you, by an expert, which I'm not."
"It sounds like you're breaking up with me."
"I'm just trying to make sure you get the best possible treatment, and I know that I'm not the doctor who can provide it, given my limited clinic hours-- and my limited experience."
"I'm going to keep making appointments with you."
"I need you to not do that."
It went on like this for a few more minutes, until I finally got my supervising attending to come in and explain to the patient that she needs a different doctor, and that the clinic will make a call for her and get her an appointment. And on the one hand, everything I said was accurate-- I can't see a patient as often as she needs to be seen, just because of my hours, and I don't have the expertise to be the best person to be treating her and managing her condition and her medications. And it's great, on that one hand, that I realize this and am willing to admit when I'm not the right doctor for someone.
But on the other hand, I'm absolutely getting rid of this patient because she's annoying and I don't want to treat her anymore. Not lying about the other stuff, just not telling the whole truth. I can't very well say, "every time I see you, I want to strangle you, so please see a different doctor and make my life easier." Or maybe I can say that, but I don't want to say that. So I'll hide behind "you need a specialist" and get this patient off my list. Way off.