‘‘The Medical Self’’ 49
for example, distinguished his care from that of ‘‘a regular patient.’’ He
spoke to me as use of new HIV medications was beginning to spread.
No one is aggressive in my care, telling me about studies. I want my
doctor to say, ‘‘We think maybe you should do this.’’ But they’re
not looking at my case, knowing what I’ve been through. I initi-
ate the conversation. I don’t know what my physicians would have
done if I were just a regular patient.
Such aggressiveness enabled physicians to avoid periods that other-
wise often occur of ‘‘waiting to see what happens.’’ Waiting produces
anxiety, feelings of helplessness, and pain of inactivity. Dan, the oncol-
ogist with chest metastases, for example, said, ‘‘I want to be more ag-
gressive. But my doctor will say, ‘Let’s get another study; let’s wait a
month.’ ’’ Assertive throughout his life, Dan now sought to remain so.
Frequently, having observed and employed aggressive treatment with
others, physicians were now less afraid of it themselves. Nancy, an en-
docrinologist with breast cancer, said, ‘‘I had this feeling: these are bad
cells, I want them off of me—which a lot of doctors with breast cancer
do. They choose a mastectomy over lumpectomy’’ (removal of an entire
breast rather than just a lump) ‘‘even though supposedly they’re sort of
the same’’ (i.e., in terms of long-term outcomes).
Dan knew the high risks of his treatment, but tried to minimize these
by getting the ‘‘best possible’’ doctors to perform the procedure. He took
advantage of the fact that known risks of a procedure reflect aggregated
statistical data that fail to account for differences between practitioners.
Though a doctor’s job was to ‘‘protect’’ patients from danger, the
calculus changed if the patient was oneself. The responsibility to safeguard
potentially vulnerable patients from harm outweighed the desire to un-
dertake such risks on behalf of others. Yet no such duty existed to protect
oneself from dangers one knowingly chose to confront oneself.
I’m willing to take more chances with myself than I am with other
people, because it’s me. A physician is a protector: protecting the
patient from himself, and from others who would be more
aggressive.
Such aggressive treatment stemmed in part from doctors’ sense that
they better understood, assessed, and could accept risks. Indeed, these
views and approaches toward risk were often deeply ingrained. Harry,