‘‘ The Medical Self’’ 43
Self-treatment created potential difficulties, too, since, as mentioned earlier with regard to self-diagnosis, problems could be overlooked and decision-making authority could be unclear. Jeff, the adolescent specialist, took the lead in his own care. But as a result, his physicians may not have followed up with him or taken full responsibility as much as they would have otherwise. Physicians-of-record may relinquish some of their control to these physician-patients. Jeff said:
I take the lead a lot. Sometimes maybe when I shouldn’ t. But my primary doctor’ s already let me have it, so she drops it. My counts dropped a couple of weeks ago. My primary doctor got the lab results, but hasn’ t called me. It might have come across her desk. But I take over, and who’ s running the show? When it works, it works really well. It saves her time and makes it easier for me. But when it doesn’ t work, things could get missed. I’ ll go fill out my own lab slip. But if I don’ t do it, they’ re not going to miss it. They assume that I’ m doing it because they know I can.
Yet receiving optimal care may require surrendering a degree of selfreliance and control. This need to yield and cooperate undermines notions, too, of patient self-empowerment. Harry, the internist and war refugee with an MI, drew analogies, describing how being hospitalized in many regards resembled being in the military.
I was in the army, which in some ways is similar to being a patient— an outside‘‘ force’’ controls you. In basic training, I tried to maneuver my fate. I went to the personnel office. I was being a smart-ass. It got me nowhere. When I let the army do what they wanted, in their own seemingly illogical way, things seemed to work out. In the hospital, you can try to modify the system as much as you can within limits— knowing the system— a little bit, so that you can wear more comfortable slippers that won’ t drop off your feet. But in the end, if I’ m relaxed, instead of fuming things will work out better.
Some physicians felt torn or even‘‘ guilty’’ about exercising aspects of self-doctoring, aware of professional propriety.‘‘ I felt guilty because I was in medicine, and wasn’ t being a scientist about it.’’ Still, many selfdoctored anyway, given competing needs. The fact that some felt‘‘ guilty’’ about self-doctoring suggested the degree to which the profession implicitly questioned this behavior.