40 Becoming a Patient
Jacob saw respect for authority as a virtue. At one point, however, he
prescribed a bone scan for himself, intimating that he may have engaged
in more self-doctoring than he perceived himself as doing.
Others varied over time in how they balanced their roles as doctor and
patient, and the degree to which they adopted the stance of patient. Jacob
added, ‘‘I went that patient route a little too far, and now am trying to get
more involved in my health care.’’
‘‘Insider Status’’ and ‘‘Remaining in Control’’: Self-doctoring
In contrast to those who ‘‘became patients’’ more fully, others strove
desperately to remain ‘‘doctors’’ and ‘‘in control,’’ in order to avoid yield-
ing power to a colleague. Their acts of self-doctoring ranged widely in
degree, from ‘‘being proactive’’ and using their insider status within the
complicated bureaucracy of managed care, to prescribing for and diag-
nosing themselves.
In some way, most ill physicians drew on their own health resources,
which were unavailable to ordinary patients. Their greater access to the
medical system allowed them to ‘‘manage’’ the system. Jeff, an adoles-
cent medicine specialist with HIV, said, ‘‘I know how to get great care
and deal with the system.’’ As a physician, he had learned skills that
he now used for himself as a patient—for example, calling physicians a
second time when phone messages weren’t returned. Since he had height-
ened access to medical information, he thought he received better care.
‘‘The system responds to me. If I were just playing patient, I would be
more frustrated. I wouldn’t be privy to all the information, or understand
the system.’’
Jeff suggested that, at least in part, one plays roles of patient and
doctor—parts one performs.
Many of these physicians were tempted to use their status as insiders
simply because they could. For example, Jeff possessed the hospital di-
rectory, which provided him with direct phone numbers.
I don’t go through public phone lines—the receptionists, the bar-
riers. I have the direct line to the doctor or nurse—the directory.
I know the nurses personally. I’ve developed connections and
friendships over years of working there. Everybody does it at their
companies.