268 Interacting with Their Patients
motivating—they lived positively with their disease. But it was
hard to watch very painful deaths, people losing their dignity,
becoming demented, their bodies falling apart. . . . I can take any-
thing, but don’t let me lose my mind! Anytime I would forget
something, I would freak out.
The prospect of dementia terrorized her and others.
Physicians who felt they became too close and ‘‘a little soft on the
boundaries,’’ posed dilemmas about balancing opposing approaches, and
defining the ‘‘softness’’ or ‘‘hardness’’ of boundaries. Jennifer indicated
how knotty maintenance of appropriate professional distance can be.
I’m sure patients thought, ‘‘Why is she so hung up about a feeding
tube and total parenteral nutrition through a central line?’’ I would
say, ‘‘You need to consider these things.’’ I probably went too far
in the other direction, giving patients much more information than
they wanted. Some staff said, ‘‘Do you think you really need to be
talking about this?’’ I’d say, ‘‘Yes, this is very important.’’ I may
have been hung up on stuff because of where I was personally. I felt
I needed to meet all of my patients’ needs, because no one was
listening to me when I would go to my doctor.
When physicians overidentified with patients, assisted suicide raised
particularly troubling personal and professional issues. Several of these
physicians encountered difficulties concerning this issue, or tried to es-
tablish and maintain clear protocols for themselves concerning these
controversial acts.
Establishing Styles of Doctoring: Distance Versus Warmth
To deal with these conflicting pros and cons of hierarchy, ill doctors also
established general practice styles: models and boundaries with which
they felt most comfortable. These physicians described a range of such
styles with regard to how close or distant to be with patients overall. In
addition to styles of nihilism versus aggressiveness described earlier in the
context of choosing doctors, this spectrum of distance versus warmth
constituted another key dimension of physicians’ approaches.
Styles of closeness could profoundly shape a physician’s practice. For
example, Jessica, the pediatrician with cancer, chose to join a group that