The good, the bad, and the ugly: (with apologies to Sergio Leone)

A physician's reputation depends on good relationships with patients, staff, and colleagues. The protection of that reputation should not be left to chance. This article identifies the good, the bad, and the ugly that physicians might encounter in their practices. Ways to assess prospective patients for their suitability for you and your practice are explored, and some of the assessment tools at your disposal--staff opinion, your face-to-face interview, and others--are identified. Second opinions have the potential to strain relationships with colleagues if not handled with care and respect. This article describes a considerate and forthright approach to providing second opinions, one that respects both patients and colleagues. Finally, physicians who become aware of individuals making defamatory and possibly damaging statements about them should act prudently, not blindly. Litigation is sometimes necessary, but the reasonable, measured approach provided here is likely to obviate legal intervention.