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Purpose: To bring to the attention of health care professionals a framework and set of ideas for conceptualising a typical patient's experience and ways to respond out of a subjective inner quality called personal excellence., Design/methodology/approach: This paper essays the viewpoint of the author on a selection of his experiences as a patient over 19 hospital admissions during his lifetime. He integrates these findings with his understanding of personal construct psychology, the psychology of change and the Greek philosophical concept of "arete" or excellence., Findings: The paper offers a theory that patients experience three kinds of emotions or anguish when admitted to hospitals called threat, fear and anxiety. These three ways of interpreting an experience of change are based on the diagnostic constructs of transition from the psychology of personal constructs or the psychology of change. The paper asserts that a holistic approach is more likely to be delivered by health care staff with a calling than those who are merely doing a job or pursuing a career., Originality/value: This paper is significant in that it draws on authentic experiences of a patient that are conceptualised into a coherent framework and linked to a well-accepted theory within the science of psychology. Further it offers an alternative to essays on quality that are confined to objective features only. It offers a way, via the philosophical concept of "arete" to tap into the subjective attitudinal dimension of quality that is often the lever or more often the impediment to enabling quality improvement programmes to be effective.