‘‘ The Medical Self’’ 63
them. As a result, physicians’ abilities are inherently limited. Mathilde thought that‘‘ Nature has a way of getting back at us. We have defeated streptococcus, staphylococcus, and maybe TB. But Nature comes up with something else.’’ Ultimately, the inevitability of aging and death curbed physicians’ powers. Harry, the war refugee, perceived this limitation starkly.
I used to tell my patients that they could cheat on their wives or their income tax, and lie to their children, but not change the forces of nature, which are immutable. We are subject to forces of nature— aging, disease, mental processes. We struggle as hard as we can against these forces, and modify and subjugate them if we can. But everybody struggles.
Harry’ s strong awareness of relative powerlessness grew, in part, from his personal experiences. As a child, he fled Nazi Germany as a refugee.‘‘ I’ m acutely aware that other forces play a major part in our lives— having to leave the country in which I was born.’’
Some felt that, in fact, doctors had the ability to reverse the course of only very few diseases, that the profession’ s perceived powers are overemphasized. Herb, the neonatologist with an MI, said:
Eighty-five percent of disease is completely self-limited, and 10 to 12 percent is progressive in the face of all treatment, which leaves only 3 percent in which you could maneuver. When do you ever give a medication that you immediately see results for? In few situations can you do something, and be present for the results.
He distinguishes between the occurrence and the observation of cures, but sees the low rates of both as supporting his point.
Yet such therapeutic nihilism can facilitate self-doctoring. Ill physicians often chose a doctor with a similar practice style who would make treatment decisions similar to these patients’ own— achieving results similar to self-doctoring, but not self-doctoring per se. Alternatively, awareness of doctors’ ultimate limitations can prompt aggressive stances, to ensure that everything that can be done is in fact done.
With different styles and approaches toward these issues, doctors may implicitly choose their patients as well. Harry said,‘‘ Every physician has a practice that reflects his or her personality. After several visits, things sort themselves out. One tries to find a doctor whose skill, worldview, human characteristics, and sentiment reflect yours, and with whom you’ re