‘‘ They Treated Me as if I Were Dead’’ 135
of her depression, Jessica feared that others would view her as unable to be a‘‘ good doctor,’’ which in turn could jeopardize her job.‘‘ People might see me as defective in some way. I don’ t admit my depression to my colleagues— they would have a strong prejudice against me.’’
Colleagues’ miscomprehensions about mental illness reflect long-standing historical and social prejudices, arising from fear and discomfort from perceived loss of control of the mind. Yet these misunderstandings among doctors have disturbing implications: these providers might inadequately treat psychiatric symptoms in their patients.
As suggested earlier, physicians can become very judgmental toward psychiatric illnesses, particularly drug or alcohol abuse, reflecting wider societal prejudices. Suzanne, the psychiatric trainee with bipolar disorder, said:
A lot of times when a doctor is getting a history about drugs and alcohol, you hear a little bit of judgment— subtle, like‘‘ When did you start doing that?’’ or‘‘ In addition to snorting all that cocaine, do you drink alcohol?’’ Whereas I’ ll say to a patient,‘‘ So, when you get really tweaked out from the coke, would you use heroin or alcohol to come down?’’ I’ m very nonjudgmental. An ER resident says to patients,‘‘ You’ re still living with your mother?!’’ Many mental patients live with their mothers. He used to say,‘‘ How long has it been since you haven’ t been normal?’’ He’ d shout at them. With a bipolar patient, I’ ll say,‘‘ So after you’ re really, really manic, and you crash, do you ever feel like you want to kill yourself?’’ It’ s like I’ m just chitchatting with somebody about the flu.
Suzanne’ s approaches, based on her own experiences and revealing empathy and intimate knowledge, can aid other physicians, too.
HIV-infected physicians encountered particular problems, given fears of potential provider-to-patient transmission. Due to such fears, some institutions scaled back activities more than required by universal precautions. For example, an HMO told Jeff not to perform pelvic exams. When he protested that these procedures were not invasive, he was told he‘‘ could do pelvic exams, but only if using double gloves’’— which are not part of universal precautions, and would decrease the sensitivity, and hence the efficacy, of the exam.
Though at first glance, HIV may appear to be a‘‘ special case’’— given fears of provider-to-patient transmission— other diseases, such as hepatitis, can also be spread from physicians to patients. Moreover, HIV