124 Becoming a Patient
Given competing time demands, doctors often had to triage, and give
less time to some patients, commonly poorer ones seen in clinics. Rox-
anne, the gastroenterologist, reported, ‘‘Doctors say, ‘This is just a clinic
patient.’ It’s not right to have two systems.’’ Within each of these two tiers,
doctors routinely provide patients different amounts of time.
But lack of time with patients can jeopardize the quality of the care.
Getting to know a patient well initially can mitigate later problems.
Roxanne said:
I had a depressed accountant as a patient. She had liver disease and
wanted me to know that she had gone to a university, even though
she had lost her job and had come to the clinic because things
had gone badly for her. Then she went elsewhere, and they treated
her for hepatitis C, and messed it up. She got depressed from
the interferon, became suicidal, and came back to see me. Had I
not taken out time, and had a sense of her, I might have missed
the causal connection—that her depression was due to her
medication.
What Are Reasonable Expectations?
In voicing these disappointments and dissatisfactions, were ill physicians
expecting too much, raising the bar unrealistically high? A critic might
argue that the shortcomings they perceived did not necessarily constitute
‘‘bad medicine.’’ After all, these physicians possessed increased knowledge
and ability to criticize their own doctors’ behavior. What is the appro-
priate amount of time that patients should wait at a doctor’s office? These
complaints often reflected larger frustrations and rage at the onslaught of
disease. But are these physician-patients justified, or simply acting entitled?
Certainly, an ill doctor may tolerate and accept his or her physician’s
alibis less. Dan, with chest metastases, said:
I wouldn’t buy the excuses: the surgical intern said that she was
in the OR and couldn’t get away. I said: ‘‘I know what surgical
interns do, and I am sure that in reality you were not essential in
July for a thoracic surgical procedure.’’
Many ill physicians anticipated obstacles, and knew full well the com-
peting demands that their doctors experienced. Deborah said, ‘‘You can’t