14 Introduction
Many insights are scattered through them, but these accounts tend to
enumerate medical events one after the other, shaped by these physicians’
experiences gathering medical histories. The focus of these books was not
to identify or explore commonalities and differences (e.g., between dis-
eases). It is also not clear how these individual contributors were chosen.
Hence, I have integrated here such doctors’ stories to present cross-
cutting issues, analyze underlying concerns, and provide a sense of the
full scope and range of the challenges faced.
Moreover, though these earlier individual and compiled narratives
represent self-reports, I have tried to shed light on aspects of experiences
that such physicians have trouble discussing as well. For example, of the
fifty doctors in Mandell and Spiro’s book, over 80 percent come out
publicly about their illness, a fact that in itself may shape what they say
or feel comfortable admitting. To avoid embarrassment, they may frame
their experiences in particular ways. Yet at times, choked by emotions,
the doctors who spoke with me couldn’t fully express themselves as they
wished: halting, and unable to complete sentences about difficult events.
Spontaneous speech differs from written text that physicians in these
other works have revised calmly over time. Such editing can conceal the
role of unconscious processes such as denial.
Nonetheless, these relatively few prior single, anecdotal cases have
highlighted certain aspects of ill physicians’ experiences with illness.
Doctors often undergo a difficult transition, denying their illness (54) and
seeking treatment late, because of attitudinal and organizational barri-
ers, including stigma and peer pressure (55, 56). They may he sitate to
relinquish the role of the physician, and instead diagnose and treat them-
selves, entering the dual roles of observing their symptoms and being
observed. Personal illness is additionally stressful because physicians fre-
quently define themselves by their work (53). Other physicians may be
unsupportive of ill colleagues (57), and can be silent, judgmental, or
avoidant, based on embarrassment and anxiety. Some ill physicians be-
come more aware of how they had previously depersonalized patients,
made them into ‘‘cases,’’ and approached the doctor-patient relationship
with paternalism and domination (58). Physicians with cancer tend to
self-doctor in some form, approaching their own care along a continuum
between typical physician and patient roles (59). Yet, within very broad
categories of being more like a doctor, or more like a patient, critical
subdivisions and distinctions may occur that have to yet to be explored.
Several strategies for treating ill physicians and negotiating the relation-