‘‘The Medical Self’’ 47
Many physicians self-doctored without thinking of themselves as doing
so. Harry, the elderly internist and war refugee, felt that he had been able
to relinquish control. He said, ‘‘I’m a patient-physician’’—as opposed to a
‘‘physician-patient’’—emphasizing one role over the other. He added,
‘‘I’m a very controlling person, basically. But under these circumstances, I
think I have the attitude ‘Do what you think is best.’ They say, ‘What do
you think?’ and I say, ‘Do what you think is best.’ ’’ Nonetheless, Harry
started treatment with an experimental medication on his own:
I initiated it. I called it to the attention of my physician, looked it up,
and asked my doctor for permission to do it. I almost always order
medications for my wife and myself. It’s much simpler that way.
Thus, his self-perceptions and actual practices of self-doctoring clashed.
Some physicians set up standards and boundaries concerning self-
prescribing, but did not always follow these either. Herb stated:
I would never write prescriptions—well, that’s not true. I will write
them. The second tick bite I had, knowing that there is a lot of
Lyme disease around, I decided to treat myself.
Herb implies a distinction based in part on the severity of the medical
problem. He self-prescribes for what he considers minor, but not major,
problems. But others might question where he draws the boundaries.
Many of these doctors treated other ill physicians, and had to deal with
the latter’s self-prescribing, observing these issues from triple perspectives.
Observations of colleagues treating themselves poorly could prompt one to
set rules and vow to be a ‘‘good patient’’ oneself. Stuart, an internist who
retired due to HIV and was now teaching at a local university, reflected:
Sick doctors who treated themselves or didn’t come in for follow-
ups annoyed me. I had to keep the ground rules straight: you
should adopt the role of the patient here, because you’ll get good
care. If you muck it up, I can’t be responsible. So I came to my
doctor with that sense of ‘‘I’ll behave.’’
Yet when treating ill doctors, such ground rules can be hard to follow.
Tensions and deceptions marked such negotiations. Herb continued:
I’d say, ‘‘I’d rather you don’t write your own scripts.’’ But a couple
of patients got a little demented and frightened, and broke down. It
became a real push-and-pull.