In the medical relationship, a special case exists with regard to reciprocity."Getting even" with objectionable physician behaviors can even lead patients to drop out of care altogether.The doctor who is perceived as working especially hard may find that the patient not only expresses gratitude, but may follow the prescribed regimen with special conscientiousness.Interestingly, because patients can choose between doctor-directed responses and responses on their own behalf, patients can hurt themselves.Mr. Brown may then express disappointment by less than full compliance with the drug that was prescribed.Thus, the need for emotional equity can, ironically, lead patients to behave in ways that are not good for their health.Of course, reciprocity may work the other way as well, producing a positive rather than a negative spiral.As an example, consider the situation in which Dr. Smith fails to provide Mr. Brown with a preferred drug.The doctor can do things for the patient, but the patient can do things both for the doctor and for himself or herself.