Conclusions 307
Lessons for Patients
In the beginning of this book, I wrote of being depressed. After several
weeks, treatment helped me, and these symptoms passed. But I re-
mained profoundly struck by the oddness and ‘‘otherness’’ of that ex-
perience. It taught me much that I wanted to understand better, and
thought might help others—both patients and providers. The experience
radically changed how I saw what I and other physicians did, the wrong
assumptions we made each day, and the width of the wall we build
separating us from patients. We may sense what the experience of pa-
tienthood is like, but don’t fully grasp it or its implications.
We try to incorporate what patients say into the terrain of our own
worlds and words. In our descriptions of patients in medical charts, after
the opening phrase—the patient’s chief complaint (the patient’s verba-
tim response to the question, ‘‘What brought you here today?’’)—we
revert to medicalese. We need at least to be aware that our accounts and
understandings are missing something that, at least according to the tes-
timony of the doctors here, is vital.
These doctors had crucial lessons for lay patients: about how to com-
municate better with providers, realize that doctors are only human, set
realistic expectations and standards, and understand the pressures and dif-
ficulties that even doctors face in the medical system. To avoid their own
mistakes, many of these physicians wanted to teach other providers and
patients. Patients need to be educated further—for example, about the
benefits of adopting a proactive stance, and how to achieve that approach
most effectively. For example, if these sick doctors found it hard to get
second opinions, lay patients must face even more difficulty. At the same
time, the intricacies of denial—its dangers—as well as the possible need
for ‘‘good denial’’ or hope need to be further recognized and explored.
The distinction between helpful and hurtful denial can be murky, but
such ambiguity may be an inevitable feature of the human condition.
Through education and reflection, patients can better understand the
complexities of choosing a doctor, appreciating physicians’ stylistic biases
(e.g., as minimalists versus ‘‘overdoers’’) and tastes (i.e., partly aesthetic
judgments). Patients can assess not simply whether doctors have good
bedside manner versus technical skill, but also what mix of these traits
might be best for a particular medical procedure and patient. Despite