Spark [Robert_Klitzman]_When_Doctors_Become_Patients(Boo | Seite 270

‘‘Us versus Them’’ 259
In their multiple roles, both professionally and personally, disease could
be an equalizer, but involved unconscious and subjective factors.
Reductions in hierarchy could have several advantages, promoting both
less distancing from physicians and passivity from patients. The power
differential reflected antagonism that physicians might feel toward pa-
tients, and could occlude necessary discussions. For example, Scott, the
physician with the foot infection, and several others reflected on the long-
standing traditional medical hierarchy, in defining ‘‘a good patient’’ as
‘‘one that doesn’t bother you.’’ Others defined a ‘‘good patient’’ as one who
adhered to medications, and was respectful. Nancy added: one that ‘‘did
not try to second-guess.’’ ‘‘Doctors really deserve courtesy, too—patients
not abusing the phone, or calling at weird hours when they can phone
during the right hours—not being a pain.’’ The realization that these def-
initions of a ‘‘good patient’’ prevailed, amazed physicians. Harry, the in-
ternist and war refugee with heart disease, was astonished when the
nurses told him, ‘‘You were such a wonderful patient: you never needed
us.’’ The fact that he was liked because of this passivity astounded and
disappointed him. This concept of a ‘‘good patient’’ appeared to exist as a
clear category in the minds of both doctors and nurses.
This hierarchy between doctors and patients can also be perpetuated
by patients’ reticence, at times reinforced by cultural and educational
differences. Patients felt disempowered, unable to ‘‘stand up’’ to a doctor
(even when to do so may have been in their interests) because they felt
they were ‘‘patients, not equals.’’
Maintaining a Hierarchy
Yet even once they were diagnosed, some doctors continued to separate
themselves from patients, maintaining rigid hierarchy and relational
power. Hegemony can serve certain beneficial ends, but it creates prob-
lems as well. Despite knowledge of its limitations and potential coer-
civeness, this hierarchy persisted, whether through direct efforts or by
default.
Many consciously relied on this power to achieve what they saw as
positive ends. For example, their authority could serve to encourage a
patient to eschew unhealthy behaviors and engage in healthy activities.
Patients might very much want—and need—to feel that doctors were
stronger and healthier. Physicians possessed an aura. Stuart said: