‘‘Us versus Them’’ 267
gave me just the littlest guilt or shame about not being there, I
would be there extra. But doing that took more and more time. . .
impinging on my personal life. . . .
Within the complex intricacies of daily practice, doctors gave out
their outside numbers for other motives as well (e.g., to entice patients in
various ways). Kurt, the internist with HIV, handed out his home phone
number in order to be seen as ‘‘the best doctor’’ in his group practice.
Other doctors in his group then resented him.
The only way I could be a better doctor was to make myself
available at odd times. In the beginning, I got off when patients
switched from their doctor to me. I would spend a lot of time
with them, give them hugs, pat them on the back. The senior docs
liked to take a lot of vacations; I would see their patients while
they were gone. But one doc yelled at me . . . three of his patients
saw me and wanted to see me again.
Kurt paid a price, too, for his weakened boundaries. Patients, once his,
would then continue to demand his time, which he found difficult to
supply. He subsequently tried to reduce the amount of time he allotted
to patients, or became resentful.
Patients could also seek, but then reject help, frustrating physicians.
Uncooperative patients, including those with drug abuse or borderline
personality disorder, received particular rebuke for requesting, but then
refusing, assistance. Antagonism can ensue as part of what psychoanalysts
term countertransference (i.e., a physician’s feelings toward a patient).
Fuzzy distinctions between doctor and patient could interfere, too,
with treatment decisions. For example, several HIV-infected physicians
reported knowing HIV-infected doctors who would ‘‘not let their AIDS
patients die, and kept them alive too long,’’ when patients’ families or
lovers thought it was time to ‘‘pull the plug’’ and not continue heroic
measures to prolong the patient’s life. Having been infected with HIV by
a needle stick, Jennifer found that her illness made it more difficult for
her to care for patients, because she feared she would suffer from their
same devastating symptoms.
I had no professional objectivity! I couldn’t handle it, and was
making bad decisions. I would say, ‘‘Don’t ask me. Just pull
the plug.’’ It was tough to see the disease all the time, knowing
so much about it. Outpatients were easier. A lot were very