‘‘ Screw-ups’’ 93
Yet such success appeared to be the rare exception. Though close colleagues may give each other feedback, it may be limited. Changes in the structure of health care delivery may have curtailed venues for such interactions. Harry continued:
In my covering group, we correct each other. Somebody might say in a nice way,‘‘ Gee, now....’’ That was wonderful about the hospital lunchroom, which doesn’ t exist anymore: Everybody came to lunch, and you could solve problems by talking to people. Professors would be there if you had physiological or biochemical questions. Now, there is less opportunity to have corridor consultations. You have to call somebody. It is difficult to see what somebody else is doing. You don’ t read their charts. Once in a while, there might be an opportunity to mention a patient indirectly, try to get a point across. But I couldn’ t say,‘‘ The nurses told me....’’
Still, in the complex system of the hospital, nurses could potentially serve a greater role as checks, providing corrections, as doctors once did for each other. Nurses have experience, observational skills, and judgment that could benefit patients, even more than at present. Yet professional boundaries can preclude optimal use of their input.
‘‘ Blowing off’’ Mild Symptoms
These ill doctors became more aware, too, of colleagues’ lack of professional appreciation of the inconvenience of seemingly minor symptoms, including medication side effects that can impair adherence to treatment. Previously, many of these doctors had merely been frustrated by patients’ failures to follow treatment. They now came to appreciate the difficulties involved far more. These physicians became more acutely aware of the stress of symptoms that they had previously minimized, or even ignored as mild or nonspecific. Symptoms may not cause abnormal lab results or necessitate biopsies, but nonetheless trouble the sufferer. Before, these doctors had frequently minimized the impact of particular adverse effects that they saw as nonspecific, and hence as potentially or relatively unimportant or even volitional. Now, they tended to identify further with patients, no longer dismissing such nonspecific complaints, but taking them more seriously. Pascal, the Lebanese internist with HIV, said: