46 Becoming a Patient
her. Even when asked, she maintained secrecy. ‘‘The oncologist asks,
‘Are you taking any medication?’ I’m not going to admit to taking the
Paxil! I don’t want them to know about it.’’ She feared discrimination,
and felt shame.
A range of rationalizations arose for self-prescribing—from conve-
nience to beli efs about innocuousness. Deborah rationalized that she was
taking only a small dose. Kurt, an HIV-infected internist who had once
used crack, now self-prescribed Prozac. He said he did not like the psy-
chiatrist he had been consulting, so now he saw none.
Maybe I still have a little residual depression. I have not seen
the psychiatrist, and have been self-prescribing the same medicine.
I stopped seeing the psychiatrist because I think he was using drugs.
Alternatively, Kurt could have found another psychiatrist, yet he felt
ashamed about his problems coping.
Some physicians self-prescribed because they felt they knew more than
their doctors did. Ill physicians may in fact have more experience than
their treating physicians—particularly if the latter are interns or residents.
Yet such perceptions may not always be correct. Dan, who had chest mets,
said:
The intern said, ‘‘We don’t think you need your patient-controlled
anesthetic. We’re going to put you on oral medication.’’ I said, ‘‘I
still get severe pain.’’ She said, ‘‘It’s going to be very difficult to
transition when you go home.’’ I said, ‘‘I’ll tell you how we could
do it very easily.’’ She said, ‘‘In my experience I think we ought
to take you off.’’ I said, ‘‘Come on—you’ve been a doctor for a
month. I’ve been a doctor more years than you’ve been alive! This is
my expertise.’’ I yelled and screamed and got what I wanted.
Still, perceptions of having more knowledge than one’s colleagues may
be only impressionistic and ego-gratifying. Pascal, a Lebanese internist
with HIV, treated himself, feeling he knew more than any other doctor in
his town. He didn’t want to consult ‘‘and pretend I’m the patient. Because
I feel I know more than any of them.’’ He laughed, hinting at a degree
of embarrassment and discomfort about his claims of superior skill, but
continued self-prescribing.
Self-prescription can lead to problems, as these individuals may dis-
agree with their own physicians’ recommendations, and may not maintain
objectivity.