130 Becoming a Patient
be here at 9 A.M . rounds.’’ I said, ‘‘I may not be able to do that.
I may be half an hour late.’’ He said, ‘‘I’m really not interested.’’ So
I talked to the head of the radiation department, and asked to
have radiation at 6 A.M . For my whole four months on that unit, I
was never late. That was not discrimination, but very harsh. I
wasn’t sure if I should confront him. I decided it wasn’t worth it.
But I used to get up at 5 A.M .!
As Deborah indicated, addressing this bias can be formidable, and thus is
avoided.
Colleagues expected each other to perform their full duties. No room
was allowed for filling only part of the role. The doctor role was all or
nothing. Thus, at times, colleagues treated an ill physician still as a phy-
sician, and refused to make any allowances for sickness. These colleagues
might have been expected to show compassion, and treat an ill physician
as they would any other patient—with empathy and concern. Instead, due
to work demands, colleagues could expect ill doctors to maintain com-
plete or almost complete responsibilities.
Many of these ill doctors experienced subtle and not so subtle forms
of peripheralization: being passed over for promotions, or no longer either
being asked to be on committees, or getting fellows to assist with re-
search or clinical duties. Brian, who had hepatitis, said, ‘‘My illness im-
pacted my competition to become director of the clinic. Someone else
was chosen.’’ Once they were perceived as sick, these doctors lost status
and power. Illness might not impair a physician’s ability to function, but
was nevertheless seen as doing so. Ill doctors were perceived as somehow
not being full or whole physicians.
The implications of these altered views can hurt. In the competitive
world of medicine, where trainees must be driven to succeed, ill phy-
sicians commonly envied colleagues receiving promotions or extra re-
sources. Scott, who had an infected foot, saw newer colleagues receive
more patients.
I’m jealous: the department got some new hotshot genetics fellow.
She’s good, but doesn’t know more than me. But they’re giving
her all these cases. Whenever they want to ask a genetics question,
they turn to her. I’ve been there for five years!
Peripheralization can manifest itself in small, but still disturbing,
ways. Bradley, who became depressed after his MI, found that colleagues