112 Becoming a Patient
people’s feelings rather than more abstract principles. But among phy-
sicians, men continue to outnumber women approximately three to one
(2). Certainly, many men interviewed here appeared warm and caring;
and not all women are equally compassionate, or necessarily more so, than
men.
Cultural differences can also exacerbate distancing from patients. Hu-
bris can separate doctors, especially from poor or foreign-born patients.
On the other hand, Deborah, for example, had attended medical school in
Latin America: ‘‘So I’ve learned a lot about communicating with people
who are poor and have nothing.’’
As described earlier with regard to medical errors, doctors received
little feedback to challenge or counter this insensitivity. Indeed, the sys-
tem and practice of medical education may facilitate or even exacerbate
callousness. Deborah observed that faculty did not teach compassion or
critique physicians who lacked it. ‘‘If somebody has a bad bedside manner,
very few people will say anything. In my training, nobody ever told me
anything about it.’’
Trainees found it especially difficult to give such feedback to senior
doctors. A rigid hierarchy separates senior and junior doctors, mirroring
that between doctors and patients. Peter, an HIV-positive medical stu-
dent, on hearing a surgeon deprecating a female patient, felt, ‘‘I can’t say
to him: ‘Hey, you shouldn’t do that!’ ’’
Pleasing Doctors: Dynamic Barriers to Communication
‘‘You want your doctors to like you,’’ Nancy observed. Many of these ill
physicians now became aware of the extent to which, as patients, they
sought to ‘‘please’’ their physicians, and the ways this desire interfered
with discussions of clinical problems. Nancy, who had brain metastases,
described how her physician-father told her she should be more assertive
with her caregivers. But she justified her reticence: it resulted from her
own psyche and her desire to get along with her providers.
You want to be a good patient, and sometimes are afraid to rock the
boat. My parents are always bugging me to be pushier. Today, they
wanted me to call to see if I could get radiation this week. Since
they bugged me, I did it. But I knew I was inconveniencing a
covering doctor who doesn’t really know me.