304 Interacting with Their Patients
doctors, over two decades have passed, and the medical profession has shifted in key ways. For example, as one set of these earlier editors observed, the doctors in these books never mentioned payment or insurance. That has clearly altered. At the least, money serves as an additional hurdle and hassle these doctors now face. Heretofore, many of these physicians underappreciated their patients’ struggles with insurance and medical bills.
But, though money has impinged on relationships, professionalism and trust persist. Doctoring is still not yet merely a job. Despite more HMOs, managed care, and shortened on-call hours, professionalism is still alive and well. In part, the processes of socialization and training remain arduous and transforming. Doctors continue to work with intense dedication and moral commitment, deriving an enormous sense of meaning. Many love their work with patients, who teach and inspire them in significant ways. Physicians’ roles represent not merely desires for, or exercises in, power, but moral commitment. Though some other careers also reflect that, not all do. These doctors touch patients physically, and have unique closeness that transforms them. Many felt they did not have the right to give up the profession, to let people suffer.
These doctors also revealed critical areas that have been less explored in the past concerning how they view hierarchy, time, risks and benefits, their medical selves, spirituality, their own poor health behaviors, and collusion with providers. In the past 20 years, medical consumerism has spread, transforming doctor-patient relations. Yet concomitantly, certain problems voiced in the past persist. Despite improved treatments, mental illness( particularly depression) remains a sources of deep stigma and shame.
More than in past reports, concerns appeared here about confidentiality. Due to electronic medical records and changes in insurance, fears of privacy now loom large. HIV demonstrates how far these concerns can go, illustrating these fears in bold relief. These narratives have broader implications as well. Their scientific training did not inure these physicians against irrational, nonscientific beliefs and behaviors. The degree to which‘‘ magic’’ and irrationality persisted in the lives of these scientifically trained doctors surprised me. They often perceived medical knowledge as overrated, and magically imbued. Despite this age of ever-increasing scientific knowledge, magic endures.