‘‘Screw-ups’’ 99
logical and social suffering involved. These physicians now realized how
colleagues often underestimated such costs. Sally, the internist with can-
cer, said:
I knew that if I didn’t get my anti-emetic before I got my IV
antibiotic, I was going to throw up for hours. So I was very insis-
tent on it. Now, I am a little more demanding that those things
be done for my patients. I try to do more now: to stress to train-
ees that it’s important to look at not only the effects of your
medication, but the side effects, and how to reduce them. Also,
make sure that things get done when you’ve asked them to be
done.
Problems with Adherence
These physicians also became more aware of other obstacles in adhering to
medication regimens, such as sticking to a schedule. Countless patients fail
to adhere completely to treatment, perceiving the advantages as less than
the disadvantages of providers’ recommendations. Once they became pa-
tients themselves, however, physicians tended to view these options dif-
ferently. Adherence is important, particularly with certain medications,
since nonadherence can lead to viral or bacterial resistance. It took be-
coming patients themselves to realize the potential difficulties.
These doctors now often failed to adhere fully to prescribed treat-
ments. Neil, the HIV-infected neurologist, said about the need for strict
compliance with medications, ‘‘I’m so busy during the day, and my denial
is so high, that I don’t take medicine. I take it in the morning and at night
when I’m not at work. Taking it breaks my ability to deny.’’
Though some physicians continued to insist that their patients fully
comply, a few now shifted their expectations and became more empa-
thetic, giving patients more slack. To be more sensitive to their patients’
difficulties and failures, many tried to use their own experiences con-
fronting these obstacles. Steven, the suburban endocrinologist with HIV,
at one point went so far as to consider changing his diet, to learn firsthand
what diabetic patients had to endure.
I was going to put myself on a diabetic diet, just to know what my
patients had to go through. Now, I’m forcing myself to go on a
structured medication regimen. It’s similar: you have to structure
your day and mealtimes.