114 Becoming a Patient
Even when not understanding important risks or benefits of a proce-
dure, patients may refrain from challenging their doctors, but simply trust
them to provide all relevant information. Simultaneously, physicians may
underestimate patients’ capacities to comprehend data. Herb, the neona-
tologist with an MI, reflected:
My doctor said, ‘‘I’d like to blast open these two vessels. . . .’’ I
didn’t say, ‘‘Let’s think about this.’’ He had an air of confidence,
and I liked his demeanor.
Herb, who treated infants, trusted his physician’s full logic, though not
understanding it.
These barriers to communication may be mutual, too, since patients
may hesitate to talk about certain medical problems—desiring to mini-
mize them because of embarrassment or denial. For instance, patients
may not want to give what they perceive as ‘‘bad news’’ to their physi-
cians. Mathilde’s husband, for instance, understated his medical prob-
lems to his doctors. She explained:
They would say, ‘‘How are you?’’ He would answer, ‘‘Oh, fine. I
exercised twenty minutes.’’ That’s pretty good when the doctors
hardly have time to get on an exercise machine. But I knew what
it took to get him out of bed, and that his will was such that he
would try to overcome any limitations.
As mentioned earlier, this passivity toward doctors may arise in part
from familial models. Yet physicians appeared not to be wholly aware of
patients’ desires to please in these ways, or of these mutually reinforcing
dynamics. Neil, the neurologist with HIV, liked patients getting better,
and was surprised when one of them sensed, and tried to fulfill, this desire.
I had a very sick patient who was given up for dead. Not that I have
a God complex, but three years later, he’s still alive. It’s been a
lot of luck. He is bed-bound, and smokes, and last month when I
was on vacation, he accidentally lit himself on fire. When I got
back, he said, ‘‘It was an accident. I’m sorry if I’ve upset you by
this.’’ I’m sorry if I’ve upset you!?
This patient felt shame and guilt at disappointing his physician. Yet Neil
was struck by the irony that he himself felt bad about having been away
when this event occurred. Thus, both doctor and patient tried to placate
one another, though neither acknowledged the other’s attempts.