‘‘ The Medical Self’’ 41
This privileged status helped in procuring referrals to the‘‘ best’’ physicians and getting appointments as soon as possible. Many of these physicians had access that permitted them to consult frequently with doctors, and obtain second, third, and fourth opinions. Jacob said,‘‘ I was two phone calls away from getting the best person in the business.’’ Daily physical proximity to experts facilitated such access.
These physician-patients were aware of the marked contrast with‘‘ how it works on the‘ outside.’’’ Here, the distinction between‘‘ inside’’ and‘‘ outside’’ referred to both geographic and social space— working inside or outside of the hospital or the profession. These two types of distinctions were also interrelated, strengthening the walls between these two‘‘ locales.’’ Roxanne, the gastroenterologist, said:
I can call up whomever I want and solicit expert advice:‘‘ Who knows about this? I want to be involved in certain trials.’’ Yet even for me, sometimes it’ s hard to get information, and I know whom to ask. So I can’ t imagine what it’ s like for some patients‘‘ out there.’’
Given the health care system, even for these physicians, accessing optimal care was often still difficult.
The advent of managed care and changes in the health care system exacerbated these self-doctoring behaviors. As the system itself has become more cumbersome and bureaucratic, proactive stances get further rewarded. In the past, physicians had a relationship of professional courtesy, treating each other for free or for whatever fee insurance companies provided. But managed care eroded this custom. Many of these physicians bemoaned the loss, which in turn furthered self-doctoring.
The desire to remain as a doctor resulted, too, from desires to avoid dependency on others. To accept illness is to relinquish control. For example, Deborah, the psychiatrist with metastatic breast cancer, primed( set up) her chemo herself. She made sure the staff didn’ t have to do anything, as she did not want to rely on others. Her actions, however, violated hospital procedures.
When I do chemo, I prep all the solutions. So when the nurses come in, everything’ s ready. The only thing they have to do is stick me. I also used to pull the IV out when I was done. But they got very concerned:‘‘ We can be cited. Because you are a patient, you can’ t behave like a doctor.’’