‘‘Screw-ups’’ 109
Faulty discussion also occurred concerning sexual dysfunction. Em-
barrassed, Jeff couldn’t mention his impotence to his doctor, and only
dropped hints. But his physician failed to grasp these clues. Poor commu-
nication or noncommunication can thus be mutual.
For a year, I tried to tell my internist that erections were a prob-
lem for me. Sometimes I wouldn’t bring it up. I wanted her to.
Other times, I would indirectly kind of say it. I only dropped hints,
because it’s embarrassing: ‘‘I’m doing fine, but wish my libido were
better.’’ Her next response wouldn’t be centered around the libido,
but ‘‘What’s your last testosterone level?’’ It would be normal, and
she would drop it. A year and a half into this, for some reason, she
said, ‘‘I’ll send you to a urologist.’’ In a month, I was back having
erections. It could have happened a year and a half earlier.
Clearly, as patients, these physicians had difficulty being explicit about
these stigmatized issues. Explicit communication was difficult. Jeff learned
he had to be straightforward, not oblique. ‘‘I have to be very direct. A lot
of patients just don’t have that ability.’’
As mentioned above, poor communication about side effects stemmed
in part from physicians’ guilt, and focus on the benefits of treatments, both
of which can also produce and result from hubris (as described below).
‘‘They Think They’re God’’: Physician Arrogance
‘‘All doctors think they’re important,’’ Dan said, ‘‘critical to the survival
of themselves and everyone around them.’’ Such arrogance often abetted
poor communication. Frequently, physicians resisted challenges to their
authority, feeling they were right and patients wrong.
Such pride can prompt doctors to conceptualize successes and failures of
treatment in self-affirming ways. At times, doctors overreported successes
and downplayed failures, defining the risks and benefits differently than did
their patients. Anne, the Swiss internist who had picked up her pathology
results herself and had seen that her doctor had not removed all of the can-
cer, disdained oncologists, disagreeing with their judgments and definitions
of ‘‘good’’ versus ‘‘bad’’ outcomes. In particular, they ignored side effects:
What they call a success often is not, and is very ridiculous—
they’re giving someone three months more of a miserable life. But