62 Becoming a Patient
Still, within these broad parameters, Sally does not wholly specify what,
exactly, constitutes ‘‘good taste.’’ The specific criteria may be somewhat
intuitive and elusive. Such an assessment may be made in part by ob-
serving a physician’s work over years. For example, Albert, who had an MI
on the highway, ended up in a local hospital, not his own. To choose a
doctor, he realized he should ask the head nurse for the name of the best
physician.
They asked me, ‘‘What cardiologist would you like?’’ Of course
I knew no one. They would not refer by name easily. And they
didn’t have a roster. So I excused everybody from the room except
the head nurse, and said, ‘‘Who would you call?’’ So I got a name.
She called him, and he came.
Nurses, after all, have observed physicians’ comparative abilities and char-
acteristics closely. Albert’s insight—to ask an experienced nurse who has
seen a range of doctors, and their successes and failures—can potentially
help lay patients as well.
Many spoke of finding physicians with similar practice styles—whether
‘‘therapeutic nihilists’’ or ‘‘minimalists,’’ on the one hand (who believe
that much disease will resolve on its own, and are concerned that physi-
cian aggressiveness can at times cause more harm than good), or aggressive
‘‘therapeutic enthusiasts’’ or ‘‘overdoers’’ on the other. Larry, a young an-
esthesiology resident with HIV, thought he should not yet start medica-
tions. Early in his career, he neither wanted to use his insurance for them,
nor could afford them on his own. He chose and liked his internist because
they were similar: both therapeutic nihilists. ‘‘I’ve read the papers, he’s
read the papers, and we sort of bounce back and forth. So far we’ve been
on the same wavelength. Everything’s been okay, because he’s not that
med-crazy.’’
Similarly, Albert, who had an MI on the highway, described himself as
‘‘conservative’’ in his medical style. ‘‘My doctors didn’t feel I had to do
anything. I thought that was good. I’m basically conservative about that.
You can get into trouble with one of those vessels blown open.’’ Here
again, the term ‘‘you’’ referred to his doctors, himself, and other patients,
his roles as patient and physician melding.
Preferences for minimalism frequently arose. This approach suggested
wariness of the potential dangers of excessive interventionism, with its
possible concomitant iatrogenic (treatment-induced) problems. In the
end, many doctors felt that Nature ineluctably eludes and overpowers