‘‘ The Medical Self’’ 55
Others rationalized that preventive medicine generally was not very effective anyway. Albert, who had an MI on the highway, believed that overall, routine physical exams, for example, were not very useful, since physicians-of-record are increasingly lax about preventive health efforts.
The arduous work hours to which physicians become inured through their training can further impede preventive health behavior. Jeff said:
Part of the training is an endurance test— irregular meals, poor sleep habits, and, unless you consider running up and down stairs exercise, irregular exercise— no balance in your life. Fried bologna at midnight for supper! The whole system is geared toward not paying attention to what a healthy lifestyle is for yourself. This is‘‘ for the patients.’’ Patients come first. We are only rewarded for cures. If patients need a great deal of education, we refer them to a nurse practitioner or a nutritionist. If they need behavior modification, they go to the psychologist. Since these things are devalued by the profession, they become unimportant to do for yourself.
Some doctors recognized the disparity between what they preached and what they practiced, but did not seem able to reconcile the two— either to advise their patients more sensitively and effectively, or to engage in healthier behavior themselves. Neil, the neurologist with HIV, said:
I don’ t truly believe what I tell my patients about the need for adherence. I take medications anyway, because I have seen that my immune status and skin have improved, and I believe that I’ ll be around for a long time— until the next round of medications comes around. But I tell them that the medications should be like breathing, or like the necessities: you eat not to starve to death, or drink water in order not to become dehydrated to death. It has to be integrated as a major part of your life because it is necessary to live, and that’ s how you have to look at it— which is a great way for them. For me, it’ s drudgery.
Hence, Neil realized the limitations of the medical recommendations he gave others, but still did not feel compelled to alter his spiel to patients. He uttered the words, but did not act on them himself.
Tensions between what they practiced and what they preached existed even despite beliefs that doctors should, if anything, abide by a higher standard. In the past, Kurt, who had used crack, had not disclosed his HIV