Dr. Paul Feldman and clinical social worker Sharon Covington -- they care for infertility patients in Rockville, Germantown and Olney -- have written a treatise on "The Perfect Patient."

Some of their recommendations deal with the infertility problem in particular. They were originally written for Resolve, a newsletter for an infertility support group.

But much that they say applies to all patients.

They tell us -- I have abridged or paraphrased in some places -- that:

"The perfect patient communicates honestly, openly and directly with the physician. This begins by abandoning the concept of doctor as God, but rather seeing the doctor as a person with special skills. Communications can then flow more naturally and are less intimidating.

"The perfect patient asks questions. Direct questions about shortcomings, possibilities of failure and alternative tests and therapies might include: What are the advantages of this test? Does it cause any pain, discomfort or complications? What are the benefits of this treatment over others?

"Answers to questions like these, or anything else the patient does not fully understand, should be very clear before undergoing tests or treatments. The patient can then follow directions more confidently.

"The perfect patient tells the doctor when he or she is failing them. One of the hardest things for patients to communicate is when they are unhappy with the way they are being treated. Perhaps one of the office staff responded curtly or the doctor sounded demeaning. The hurt from such incidents can go deep and ultimately affect the doctor-patient relationship.

"However, the doctor cannot be held accountable without the opportunity to respond. Both the positive and negative issues that occur between doctor and patient need to be discussed, not avoided.

"The perfect patient seeks education. From the doctor, from other staff, from reading. Ask about useful reading.

"The perfect patient finds ways to reduce the stress caused by an illness or problem. Stress is normal, expected and usually not permanent. However, support mechanisms may be needed -- support groups or seeing a therapist whose specialty is counseling.

"Hobbies, vacations, exercise and social interaction -- finding other people with whom to share feelings -- can help make the problems less overwhelming.

"The perfect patient -- if married or otherwise with a companion -- approaches illness as a couple problem. The fact that one person may be identified as having a problem does not negate the effect on both. A workup, evaluation and treatment are much better dealt with when the spouse or companion participates in at least some visits and has a good understanding. The more involved a couple is, the better able they are to support each other and make a decision on options.

"We feel that the perfect patient is an active participant in the treatment process rather than a passive recipient of medical intervention. Such patients see the physician as a person, not a deity, and thus don't need to act like angels, silent in the wings.

"Ultimately -- and at least to a great extent -- patients are responsible for their own health."