‘‘Us versus Them’’ 271
Other physicians came to take a different approach to decision-
making by presenting more choices: not necessarily sharing decision-
making, but making it more transparent and giving patients more leeway.
Even Dan, with chest metastases, who had always been very assertive,
now became ‘‘less dictatorial.’’ ‘‘I’m offering my patients more choices:
‘We can do A, B, C, or D—I think we ought to do A, but if you want to
do B or C, we’ll do that.’ ’’
Here, too, doctors tried to adapt their styles to meet their perceptions
of individual patients’ desires. Suzanne, the psychiatrist with bipolar
disorder, said:
I’ll sense what patients need. If they need me to just take control
and be the authority, I’ll do that. If they need to be the one making
choices, I’ll do that.
Yet determining patient preferences can be intricate. Patients may or
may not concur with their physicians’ assessments of how ‘‘authoritari-
an’’ to be, and may change over time.
In sum, their experiences as patients led many of these physicians to try to
establish an appropriate balance of ‘‘detached concern,’’ varying from
upholding a traditional hierarchy between doctors and patients on the
one hand, to becoming more ‘‘equal’’ with patients on the other. At
times, this hierarchy—encompassing properties of aura and magic—
turned out to be a powerful tool, sought by patients. These doctors them-
selves possessed a ‘‘placebo effect’’ that could help patients ameliorate
anxiety and uncertainty. Yet medical training rarely, if ever, explicitly
taught or discussed such ‘‘magic.’’ This hierarchy could grow, too, from
physician callousness and antagonism, separating doctors and patients,
and widening due to competing demands on physicians’ time. This
power, reflecting both magic and relational authority, could take on a
range of forms. Many physicians now felt closer to patients, but still
struggled to avoid overidentification and to gauge how close to be, adopt-
ing different styles over time. In grappling with these boundaries, they
followed different models of decision-making, from ‘‘the doctor knows
best’’ to the doctor merely providing options and letting patients decide
by themselves.
Medical information emerged, then, not as a monolithic or static
entity, but rather as something exchanged in variable, dynamic contexts
of doctor-patient relationships, in which decision-making played key