Spark [Robert_Klitzman]_When_Doctors_Become_Patients(Boo | Page 53

42 Becoming a Patient Deborah did not oppose getting the treatment, but being given it by others, which represented dependency. These physicians found it hard to accept help in part because both the profession of medicine and the prevailing American cultural ethos encourage rugged independence. Deborah resisted entering the sick role in other small but symbolic ways as well. As a result, her oncologist admonished her to ‘‘be a patient’’: My oncologist says, ‘‘Why don’t you put a gown on and be a pa- tient for a while?’’ I don’t change into the gown every time. She does a physical exam, and I don’t change until we talk. She gets upset and says, ‘‘You should really be a patient!’’ But I don’t want to. Similarly, as a patient in the hospital, Dan, the oncologist with chest mets, who had been assertive throughout his life, insisted on wearing surgical scrubs rather than patient pajamas. The hospital staff have seen me over the years and know who I am. But it’s very strange to sit there in a hospital gown with my butt hanging out. When I go for my scans, I bring along a pair of scrubs, and change into scrubs, rather than into one of their sets of patient pajamas which, because of my girth, don’t fit me. Additionally, many doctors are controlling by nature; and self-select to enter the profession. Premed courses and medical school encourage and reward obsessive traits, weeding out individuals with more casual attitudes. Harry, an elderly internist and World War II refugee who had a myocardial infarction (or MI), said: It’s the great failing of most physicians: they are controlling peo- ple. But to be a good patient, and get the best care, you have to say, ‘‘I’m the doormat. You can do what you want,’’ and not second-guess. Medicine may attract individuals who also seek mastery over disease and death. When they were young, several of these doctors observed dis- ease in a family member or in themselves, and vowed to try to conquer it. Self-doctoring could result, too, from more overt denial. To enable doctors to perform their job, a degree of denial may be necessary to allow physicians to be physically close to patients, despite potential fears of contagion. But patienthood can exacerbate this denial, which can prove maladaptive and interfere with treatment.