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tient through death did not work. Stuart’ s comment that doctors will‘‘ never be patients’’ further underscores the fragile illusion here.
Avoiding the Risks of Overidentification
As noted in the beginning of this chapter, physicians who sought to equalize the roles of doctor and patient risked going too far in the opposite direction— blurring roles and boundaries too much. Doctors could overidentify or become overinvolved with those in their care. They were not always clear on how close or social to be with patients, and had to gauge what were, and should be, the boundaries between the two sides. In small towns, this potential for sociability and hazy boundaries led a few doctors to seek treatment elsewhere.
Particular problems arose in treating friends. Nonetheless, a few physicians ended up doing so. Occasionally, friends became patients, or vice versa. Mark, the HIV-infected internist interviewed in the diner, said:
Generally, they’ re friends first. I’ m flattered they have that much confidence in me. I figure in general I’ ll take better care of them than anybody else would, because I really care.
Doctors felt threatened, too, seeing patients younger than themselves dying. Only at such a point did Walter, for example, feel vulnerable himself.‘‘ When your patients who have serious illness or are dying are your own age or less, you feel that it could happen to you, too. I can’ t separate out those threats.’’ He implied here, as well as earlier, that he had resisted and denied his own mortality.
Boundaries can also muddle for physicians who share diagnoses with their patients. These doctors tried not to think about the fact that ill patients could be them. Yet such efforts at avoidance did not always succeed. Paul said:
I think all the time,‘‘ God, that patient could be me.’’ You don’ t let yourself get there. If you get too close, you’ re going to fry. I’ m sure there’ s huge denial there.
Dangers lurked, but as Paul realized, attempts to avoid such identification could border on maladaptive defenses with added psychic costs. Doctors risked overidentifying with patients because of sharing not just medical diagnoses, but also other psychological or personal characteristics. For