54 Becoming a Patient
Here again, recognition of avoidant behavior was not sufficient to elimi-
nate it.
Substance abuse also emerged—including the use of recreational drugs
that were perceived as unhealthy, particularly for those with impaired
immune systems. Physician stress can compound substance abuse. Indeed,
doctors may have higher rates of abuse of certain substances than do
nonphysicians (1).
As a result of beliefs in invulnerability, doctors often protect them-
selves less than they should against disease. They may self-protect less
than nurses, who generally do not follow as ‘‘macho’’ an ethic. Stuart
observed, ‘‘The doctors are the last ones to wear protective gloves. The
nurses are much more likely to do so.’’
Even more dangerous, several doctors who had lowered immunity, mak-
ing them acutely vulnerable to disease, nonetheless still treated infectious
patients. This behavior suggested both commitment and denial. Lou, who
debated removing the award from his wall, in retrospect perceived such ac-
tions as having been unwise. ‘‘Maybe that wasn’t so smart, because my white
blood cells went down to zero. But the Good Lord smiled down on me.’’
As indicated, a variety of rationalizations could arise. For years, Sally,
the internist with cancer who brought her laptop to the ICU, had
avoided seeing a doctor, using the excuse of ‘‘never having enough time.’’
I was ‘‘too busy.’’ I got basic blood testing done, and figured if that
was ok, I was ok. Then, I had a high white count. So I asked a
colleague to look at me. This colleague is still beating herself be-
cause she didn’t feel the enlarged spleen tip.
Jessica rationalized that many other professionals had personal prob-
lems, too. Hence, she didn’t need to consult a mental health professional
for her depression.
I think: why is it that most psychiatrists and psychologists are
crazy? Or family counselors are divorced and are not speaking to
their relatives? The flesh is weak.
Perceptions of laypeople’s shortcomings justified these doctors’ own,
and eased guilt. Kurt sought to justify unsafe behavior as not being un-
usual: ‘‘A lot of people I know take some risk: get drunk, do drugs, throw
caution to the wind.’’
Yet Kurt had gone further than many by using crack, which is highly
addictive.