28 Becoming a Patient
eases about which they are learning. Students then overdiagnose them-
selves when they are in fact completely healthy. In contrast, post-resi-
dency disease involves worries about legitimate physiological disorders,
and can in fact lead to decreases in care sought, or to various forms of
self-doctoring. Hence, the consequences can be more serious. Medical
student’s disease, after all, is a response to nonexistent medical symp-
toms, while post-residency disease refers to symptoms and diagnoses that
could threaten to terminate one’s life and career. After medical school,
physicians can still suffer from hypochondriasis. But here, ‘‘post-residency
disease’’ proved far more prevalent and involved denial—not worry-
ing too much, but too little, about medical problems. Health profes-
sionals appeared to cross the divide between ‘‘medical student’s
disease’’ and ‘‘post-residency disease’’ after they had extensively treated
patients’ diseases, and now had a real disease themselves that needed
treatment, evoking fears of mortality and triggering psychological
defenses.
Self-diagnosing
The initial stage of these physicians’ passage into patienthood was diag-
nosis. This stage proved far more intricate and challenging than they had
anticipated. Many diagnosed themselves, assessing their own prognoses
and treatments.
Yet errors clouded these judgments. Some physicians minimized or
failed to recognize the significance of their initial symptoms, and didn’t
use their medical thinking—they failed to think of themselves as patients
or to look at themselves as a doctor would. Jim, the pharmaceutical
company researcher with leukemia, didn’t view his early symptoms as he
would if they had been those of another patient.
For about a week, I had been sick, and thought it was the flu. But it
got worse. So I saw my physician and was diagnosed with leukemia.
I was surprised. I had been thinking about what else this could be
besides a flu. I was even doing some reading, but I just never used the
kind of medical thinking that I might have with somebody else, and
said, ‘‘Let’s go through everything: Is it infectious? Autoimmune?
Malignant?’’ I could have picked up on other clues, but didn’t: I cut
myself shaving, and it took a while to stop bleeding.
Even after the disease was identified, Jim still doubted it. He continued: