When given a choice, how do people decide which physician to select? Although significant research has demonstrated that how people actually feel (their “actual affect”) influences their health care preferences, how people ideally want to feel (their “ideal affect”) may play an even greater role. Specifically, we predicted that people trust physicians whose affective characteristics match their ideal affect, which leads people to prefer those physicians more. Consistent with this prediction, the more participants wanted to feel high arousal positive states on average ([ideal HAP]; e.g., excited), the more likely they were to select a HAP-focused physician. Similarly, the more people wanted to feel low arousal positive states on average ([ideal LAP]; e.g., calm), the more likely they were to select a LAP-focused physician. Also as predicted, these links were mediated by perceived physician trustworthiness. Notably, while participants’ ideal affect predicted physician preference, actual affect (how much people actually felt HAP and LAP on average) did not. These findings suggest that people base even serious decisions on how they want to feel and highlight the importance of considering ideal affect in models of decision making, person perception, and patient physician communication.