44 Becoming a Patient
Varieties of Self-testing
As indicated above, self-doctoring can include several stages: self-
diagnosing, self-testing, self-prescribing, and self-interpreting of tests.
Some physicians ordered diagnostic tests because, they argued, getting
other doctors to do so was hard or inconvenient. Scott, an internist with a
foot infection, chose his own diagnostic tests, even arranging to grow the
infectious agent that caused his cellulitis. ‘‘I cultured the stuff: collected it
in a sterile tube. None of the trainees wanted to culture the stupid thing.
Even the surgeon didn’t want to!’’
Self-doctoring can also involve researching one’s illness, including pro-
viding information to one’s physicians—‘‘filling in the gaps,’’ performing
tasks that otherwise might not get done. Sally, an internist with cancer,
loved her work, calling it her ‘‘therapy.’’ When hospitalized in the in-
tensive care unit (ICU), she brought along her own laptop and conducted
Internet searches on aspects of treatment about which her physician said
he could not find any articles.
In the ICU, I did my literature search. The attendings couldn’t
find the literature on my condition and low calcium. It took me
about five seconds. They didn’t really look. I went to Medline and
typed ‘‘hypocalcaemia with pneumocystis.’’ Out came five wimpy
articles. But these doctors said they couldn’t find anything!
Ill physicians arranged not only to access certain procedures, but also
to avoid others that they deemed unnecessary. Herb, a neonatologist in
his sixties with an MI, for instance, was able to eschew invasive proce-
dures that he felt were not fully warranted: ‘‘A cardiologist friend said
I could pull my IV out, call a cab, and go home, and my prognosis would
be identical.’’
Self-prescribing
Among self-doctoring behaviors, the most controversial and potentially
dangerous was self-prescribing. Commonly, these doctors ordered med-
ications for themselves, determining types, amounts, and lengths of drug
treatment. Yet self-prescribed drugs can range from the innocuous to
the risky. Implicitly or explicitly, self-prescribers had to face questions of
whether these behaviors were inappropriate, and where, if at all, to draw
the line. Moreover, only these doctors themselves—not their physicians-