108 Becoming a Patient
For patients, these comments remained palpable. Even innocent com-
ments had profound effects because of their implications.
Doctors varied as well in how much information about side effects
they provided to patients beforehand. Some failed to explain important
treatment complications. For example, no one had told Deborah, the
psychiatrist with metastatic breast cancer, that her hair would never
grow back after radiation. ‘‘I think they all thought that I knew. But how
would I know? It’s not my field.’’
As suggested earlier, her doctors may also have felt uncomfortable
discussing these side effects with Deborah because of their implicit guilt
at harming patients.
Questions arose, too, of when patients were ‘‘informed enough.’’ The
answer varied, and was not always clear.
Several doctor-patients were surprised to glean important facts not
from their physicians, but from others. Such lack of communication from
providers occurred about taboo areas, including not only death, but also
mental health and sex. Bradley learned of potential post-op depression
not from his own cardiologists, but from his doctor-son. Similarly, Tim, a
young, recently married dermatologist, was not told by his physician that
he might become sterile after radiation therapy for his leukemia. Luckily,
a friend informed him.
Physicians-of-record not only revealed ignorance about the experience
of psychiatric symptoms, but communicated about these topics poorly.
Jeff, the adolescent specialist, described how his mental health symptoms
were inadequately assessed by his physician, who, as a result, missed a
diagnosis.
I told her, ‘‘I think I’m depressed.’’ She asked about appetite and
weight change. But all these were negative, so she said I wasn’t
depressed. But she superficially skipped over it. She needed to
really delve into it, to say, ‘‘I want you to see a counselor.’’ I think
my unsafe sex was depression-related. She should have found
out why I said I was depressed, especially since I’m not just