‘‘The Medical Self’’ 51
I’m saying, ‘‘Let’s do it off-protocol. I know enough to give in-
formed consent.’’
With patients, doctors ordinarily try to find the appropriate balance
between erring a little on the side of too much versus too little treatment,
and most tend to be cautious. Harry, the internist and war refugee, said:
Compulsive overdoers order every test in the book. Maybe they are
insecure. But it costs somebody a lot of money and blood. Occa-
sionally, they find something that they didn’t suspect. But you
hope to do the proper amount of tests. You want to be in the
middle. Which is worse—overdoing it a little or underdoing it a
little? I overdo it a little—I hate to stand there with egg on my face.
But I always attempt to have some justification.
These differences also underlay the questions patients commonly
ask their providers: ‘‘What would you do if you were me, doctor?’’ or
‘‘What would you do if your mother were the patient?’’
As a result of being a patient, a few doctors occasionally did become
more vigorous in treating their patients. For example, some tried to pro-
vide test results more rapidly. A few tried to order treatments more ag-
gressively, too, but this alteration was rare. Pascal, for example, said that if
he were not HIV-infected himself, he wouldn’t push as much for his
patients as he did now.
I am much more aggressive in finding other ways of doing things.
I don’t think I’d be as aggressive, or come up with novel ways of
treating patients when I’ve run out of options, exploring things that
you can only get through compassionate use, or combining mul-
tiple medications—things a ‘‘straight’’ doc wouldn’t do. He’d
think, ‘‘Well, this drug doesn’t work . . . you’re dead anyway.’’
Other ill physicians wanted to be more assertive with patients, but
refrained for various reasons, in part legal liability. Harry, the war ref-
ugee, explained, ‘‘Malpractice is somewhere in the back of my mind. We
physicians are more aware of the consequences, and can deal with the
side effects’’ (i.e., when treating themselves).
But these doctors suggest that perhaps norms should change—patients
should be offered riskier treatments when no other therapy is available,
providing these patients can understand the risks and benefits involved—
which they frequently can.