‘‘Magic White Coats’’ 31
Doctors rejected the patient role in particular when the disorder was
psychiatric, suggesting that acceptance of the sick role can vary widely,
based on the nature of the disease. Accepting potential threats to one’s
mental functioning was extremely hard. Suzanne, a psychiatric trainee,
said about being diagnosed with bipolar disorder:
I am a highly functional person, and had to admit that I had some
paranoid ideation. It was really hard to accept needing an anti-
psychotic. I was entering a new category.
Resistance arose to transitioning not only from healthy to sick, but
also from minor to serious illness. Brian, a young pediatrician, acquired
hepatitis C from a patient. He felt that he crossed a critical boundary
when he moved from merely being infected into the ‘‘land of more ad-
vanced disease.’’ Hence, within the broad category of the ‘‘sick role,’’ key
subcategories of various ‘‘symptom roles’’ emerged that affected these
individuals’ lives.
Resistance to adopting the role and identity of patient can extend to
numerous realms of one’s life. Lou, the pediatrician with the award on
his wall, tried to stay active, determined that nothing in his life would
change. He saw his response as ‘‘denial,’’ and defended it.
I passed an internal law: if I fatigued early, I would exercise more. If
my stomach hurt, I would eat more. I swam and ran more. Rest
is not useful! If you’re not using the brain, it atrophies. Nothing
changed . . . except I lost my hair.
Lou dealt with his illness by acting as if it did not exist. ‘‘I had an
unreality about it: I was not sick! I dealt with it by denial, essentially ig-
noring it.’’
Yet such rejection of illness could extend to the point of impeding
health. For example, at times, doctors, though suspecting and fearing a
disease, resisted diagnostic testing. Many delayed the initial steps re-
quired to get a full or official diagnosis. Paul, a young internist, later lost a
job offer because of being HIV-positive. Earlier, he had postponed HIV
testing, suspecting that he was infected, just as he was embarking on his
post-medical school training.
It took me a year to get tested, because I was starting residency, and
didn’t really want to know I was positive, and have that hanging