‘‘Screw-ups’’ 125
expect to feel well taken care of all the time. They have other
patients. . . . It’s a very busy breast cancer floor, always full.’’
However, the goal here is not to criticize health care providers, but to
pinpoint areas that can be improved. Indeed, these doctors often under-
stood and acknowledged colleagues’ imperfections. Providers may fail to
‘‘make the right decision’’ as a result not of ‘‘medical error,’’ but of the
inherent uncertainties of clinical care. The ‘‘right thing to do’’ may be clear
only in retrospect. Consequently, certain problems may be inevitable.
Still, some of these doctors felt that often patients simply wanted too
much. Jeff, the adolescent specialist with HIV, commented, ‘‘We just
don’t know everything, and can’t be expected to.’’
But even as fellow practitioners, these doctors felt that their expecta-
tions were reasonable, and their disappointments valid. Even if a critic
might argue that these doctors were asking for too much, they did not
think they were doing so. These physicians also generally took as a stan-
dard of comparison their own behavior—not abstract or platonic ‘‘ideal’’
care. Sally, the internist with cancer who brought her laptop to the ICU,
recognized that ‘‘we all make mistakes,’’ but that doctors have bases for
assessing the care they receive. ‘‘Doctors are more aware of errors because
they have a database from which to judge. But I’ve learned to be forgiving.
I know I’ve made mistakes . . . we all do.’’
In sum, in entering the role of patient, these physicians faced a wide series
of internal and external problems. Professional socialization fueled a sense
that they wore ‘‘magic white coats’’ and could not get sick. In part as a
result, they displayed symptoms of ‘‘post-residency disease,’’ marked by
various types of denial—from delaying initial diagnoses to ignoring pro-
gressive markers of illness, verging at times on magical thinking. Some
felt they exercised ‘‘good denial,’’ but the definitions and boundaries of
‘‘good’’ versus ‘‘bad’’ denial can be hard to see and assess in oneself.
They frequently relied on ‘‘insider’’ status, yet nonetheless confronted
obstacles due to insurance and bureaucracies, which surprised them.
Though a few received VIP treatment, many more experienced screw-ups
in care. They recognized their own past mistakes, but were still astonished
at others’ errors—even those of colleagues whom they respected.
Through their odysseys, these ill physicians became more sensitive
to patient perspectives, concerning the difficulties of side effects, treat-
ment adherence, and inexpressibility of even ‘‘minor’’ symptoms such as
pain, fatigue, nausea, a