Ask a primary care physician what the best part of being an attending is, and more often than not, they will tell you “the continuity.” It is that comfort you develop when you have repeatedly seen patients over the years and watched them grow and change. It is that unique experience of getting to be part of their lives, their stories, their hardships, and their successes. In a residency clinic, it becomes more challenging to replicate that continuity. I am lucky if I know one or two patients on my schedule for the day. Often, it is a pleasant surprise to recognize faces or remember a unique fact about a patient. Yet, I can tell you without shame that I certainly have my fair share of favorite patients.
My favorite patients tend to be similar to T. The first time I met T, she had been hospitalized for the first time in her life due to a new rheumatologic diagnosis. She was haggard and exhausted, and she broke down crying after I asked her how she was doing with the recent changes in her life. My eyes welled up during the visit while hearing about everything she had gone through, and I admired her hope and faith that things would improve. During that visit, I primarily placed referrals to her specialists, and on paper, I didn’t change much regarding her medical care. At our second visit, her smile was radiant as she told me how much better she was feeling and how she wanted only me to be her primary care doctor. This time, I shed real tears.
Certain factors make some patients easier to care for — whether it is shared identity, personality fit, or simply their approach to their health. In my practice, I find myself connecting most easily with English-speaking women and adolescents of color, often with chronic illnesses. I see myself in them. They tend to care about their health, follow my recommendations, and make me feel I am making a difference. I remember the patients who light up when I recall details about their lives, take my advice seriously, or trust my medical opinions. It is a cherished, yet selfish feeling that keeps me going and reminds me why I went into medicine.
I also wonder what this means for my other patients, the ones I don’t immediately click with. What about the elderly woman who requires an interpreter at every visit, the patient who repeatedly cancels appointments, or the patient who is skeptical of medications and physicians? I treat all my patients with respect and compassion, but in reality, some interactions feel more natural than others. In some encounters, the relationship does not come effortlessly, and I work harder to create rapport. I have faced the challenge of accepting that some patients may distrust or dislike me, often for reasons outside of my control. Primary care is relational, and it turns out most of those relationships are not the same. But is it problematic to have “favorite” patients, and what does that mean for the care we provide?
Clinicians’ unconscious biases can influence medical decisions, sometimes resulting in disparities in care. My clinical decision-making is frequently influenced by my past experiences with a given patient, whether positive or negative — a bias called the affect heuristic, in which emotional responses unconsciously shape treatment choices. Additionally, like all clinicians, I can fall victim to confirmation bias and selectively interpret information to align with my existing perceptions of a patient. Even though patients are dynamic, I only see a small snapshot of their lives, and I may unknowingly use these brief impressions to judge how likely they are to follow my recommendations. If I believe they aren’t likely to follow my advice, I may even give up on motivational interviewing — all without realizing that I’m acting on a bias.
These unconscious biases don’t exist in isolation; they spill over into other patient interactions through countertransference, where clinicians project feelings from past experiences onto new encounters. If a patient physically resembles another patient I had a negative experience with, for example, I may instinctively draw parallels between the two patients even when they have little in common medically. This makes establishing a rapport with the new patient harder and can further complicate the divisions between connection, preference, and impartial care.
There is also the question of boundaries: How close is too close with patients, especially when that connection is strong? During one appointment, I balked when T asked me how old I was and if I was married. Viewpoints on boundaries vary within medicine, but here’s what I’ve landed on: I don’t give my personal cell number to patients, I try to keep messaging to within work hours, and I avoid sharing personal details when possible. I do engage in small moments of connection, however, like remembering a patient’s life updates or birthday plans. I also let certain patients confide in me about struggles beyond medicine — family conflicts, job stress, and relationships. I occasionally bend the rules with patients I feel closest to and play other roles beyond ‘primary care doctor,’ including therapist, coach, teacher, or trusted non-parental adult. I would not prescribe my particular boundaries to other clinicians, but they are the ones that feel authentic to me at this stage of my career.
In the majority of specialties, clinicians reveal nothing about themselves for safety and work-life separation. Primary care is different — we see our patients regularly, often for years. Our care is contingent upon the trust we build, and it is most effective through relationships that grow incrementally. The question is not whether personal connection is a part of primary care — it’s how much we let it guide our practice. Part of that means recognizing our preferences, questioning our biases, and actively working to ensure that every patient, whether we connect with them instantly or not, receives quality care. Having favorite patients may be an inevitable part of medicine, but what matters is how we respond to that reality.
What boundaries do you keep (or not keep) with patients? Share your personal preferences in the comments.
Dr. Brinda Sarathy is a family medicine resident at the University of Colorado in Denver, Colorado. Within medicine, she is passionate about gender-affirming care and reproductive health access. In her free time, she enjoys running, hiking, listening to obscure podcasts, and cooking new recipes. Dr. Sarathy is a 2024–2025 Doximity Op-Med Fellow.
Patient initial and identifying details have been changed.
Illustration by April Brust
