306 Interacting with Their Patients
may impair their own care, and be more difficult than lay patients in going‘‘ too far’’ managing their own case. Yet this phenomenon depends on the extent of the physician’ s illness and expertise. Self-doctoring can foster a minimization of disease, the sense that one can manage one’ s own problems. Hence, denial can promote self-doctoring and vice versa.
Ill physicians may be‘‘ worse’’ than lay patients in having the power and authority to compel doctors to defer to them in denying problems. Generally, if these ill physicians did not want to get care, no one in their family or social networks could push them.
Moreover, collusion occurred— doctors selected physicians for themselves to accomplish the same ends as self-doctoring, reinforcing resistance to entering the role of patient. But such collusion has received little, if any, attention.
‘‘ Good denial’’ arose, too, as a concept, representing perhaps no more than hope. Yet the demarcation between good and bad denial was not always clear: who determined it, how, and with what accuracy. Talcott Parsons suggested that doctors’ functions are to‘‘ do everything possible’’ for their patients. These doctors pursued this standard for themselves, but were often less able to do so for their patients, due to financial constraints. This double standard needs to be appreciated more fully, so that if they wish, some patients can be offered choices of‘‘ riskier’’ treatments that doctors might ordinarily seek for themselves, but not for their patients.
These physician-patients found coping hard, and could benefit from enhancements in colleagues’ and others’ attitudes and available supports. Yet these physicians generally avoided support groups that help many nonphysician patients. Doctors don’ t want to be seen as‘‘ the expert in the group.’’ The presence of a physician member could turn the group into a‘‘ let’ s ask the expert’’ session. But a network could be created of ill doctors who could offer peer support to each other. This could be done at least in part online, or through periodic meetings. Support groups of HIV-positive doctors, generally initiated earlier in the epidemic ad hoc and informally from the ground up, often functioned for a while, until members became more severely sick or died. Then, these groups tended to fizzle out. Nonetheless, such entities could be effective, particularly as doctors become older, to discuss these issues. Local medical societies could more actively support such groups and networks. Possibilities for such peer support, in part through local and national physician organizations, should be further explored.