when a patient develops a pre-conceived notion of their condition they might be resistant to the diagnosis provided by the physician. The physician will likely have to spend additional time attempting to convince the patient to accept the diagnosis and become adherent to the prescribed treatment. If it is at all possible for the physician to convince the patient of the diagnosis, the likelihood of the patient – physician relationship being tarnished is a strong possibility. Additionally, in the world where we attempt to apply a rating or score to everything the patients rating of the physician is likely to be influenced.