188 Being a Doctor After Being a Patient
Dangerous Knowledge: The Disadvantages and Limitations
of Medical Information
As patients, these physicians came to realize not only the advantages, but
also the potential limitations, of medical knowledge. Frequently, they
came to see medical information as overrated, open to wide and varying
interpretation. Many had previously seen medical science as straightfor-
ward, and now perceived ways it fell short—often painfully so. They re-
alized how doctors and patients differ in tolerance of, and needs for, data.
At times, even for these doctors, information now became ‘‘too much.’’
Possession of medical knowledge had downsides, as it included informa-
tion about poor prognoses, possible complications, and errors. One aspect
of illness that may be more difficult for a physician is knowledge of the
eventual severity of a diagnosis—knowledge that providers ordinarily
might minimize or not communicate to a patient, ‘‘the things the doctor
doesn’t say.’’ Physicians knew the complications and problems of their
own diseases. ‘‘I knew what it was like to watch a lot of people die,’’
Jennifer remarked. ‘‘I couldn’t pretend I didn’t know.’’
Doctors had witnessed the horrors of possible differential diagnoses,
the worst possible symptoms and complications. These experiences
shaped fears and observations in ways that did not extend to the same
degree when these doctors treated other patients. With regard to them-
selves, they were far more subjective. Many feared negative outcomes more
for themselves than for their patients. John, the public health official
with HIV, pointed out:
I know all these horrors that can happen, and it’s very easy for
those to prey on my mind. Whole differential diagnoses go through
my head. When I had knee surgery and a fever, I had been doing
a lot of autopsies, and was worried about the worst complica-
tions. After I had HIV, I got a rash, and was convinced it was thrush
or yeast. Then I had herpes, and was convinced the HIV made it
worse. But it could have just been the stress of worrying about
whether it was HIV. People who aren’t physicians experience that,
too, but I think it’s harder as a physician.
Still, as John intimated, such comparisons with lay patients are difficult
to make.