As early as 1981 Gorlin and Zucker produced a film, A Complicating Factor: Doctors' Feelings as a Factor in Medical Care and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role.