"A patient who feels I have failed him or her can be disappointed, but there is a big difference between a trial of therapy and then fine-tuning it based on the results and being accused of being inept. Prior to any treatment, I would educate the patient on any remedy in which the results--successful or unsuccessful--would be helpful. If unsuccessful results soured our relationship to the point where I faced an uphill battle in convincing the patient why he or she should continue with me, I would recommend referral to another dermatologist, based on the absolute need for a patient to have confidence in me. The patient is already angry, and if the anger cannot be removed and replaced with good faith, discharging him or her won't make things any worse and may even limit my liability and that of those with whom I'm associated."