64 Becoming a Patient
confident.’’ Consequently, doctors and patients may each, to a degree,
self-select.
Doctors may also assess and take into account these differing styles in
deciding to whom to refer patients for treatment. As Harry put it:
There is this wonderful business: if you refer a patient for che-
motherapy, you have a choice of sending them to a therapeutic
nihilist or a therapeutic enthusiast, or anything in between. You
know who’s doing what before you send the patient to them—
what they’re going to do. You determine to some extent the pa-
tient’s therapy. Should you tell that to the patient? That’s the
issue I present to students. I did and didn’t tell, depending on the
patient.
Yet conversely, barriers can arise to finding and being able to choose a
doctor who matches one’s own ideal approach. Insurance plans can limit
choices of physician. Harry described himself as being at one point a
‘‘prisoner of a minimalist.’’
Good Bedside Manner versus Technical Skill
Technical skill, and the balance between it and ‘‘bedside manner,’’ also
shaped choices of the interviewed physicians. Among these ill doctors, a
minority emphasized that for particular types of medical problems and
treatments, empathy alone was insufficient. Harry, the war refugee, said,
‘‘I know a son of a bitch who’s a wonderful surgeon.’’
The appropriate balance between humanism and scientific ability
could depend on the medical problem faced. To a friend requiring sur-
gery, Harry therefore recommended technical skill over ‘‘niceness.’’
A good friend was diagnosed with carcinoma of the uterus, and
went to the cancer hospital’s surgeons, who always just cut ev-
erything out. There are untoward side effects, but the cancer
hospital doesn’t care about that. They just want to eradicate
Cancer, with a capital C. She had only a little bump in her myo-
metrial wall. So I said, ‘‘Go to Dr. X. He’s a wonderful surgeon,
but not only doesn’t talk much to his patients—he’s nasty.’’ She
interviewed him, and he just insulted her. He said, ‘‘We’ll get in
there, do a biopsy first, and see what needs doing.’’ He did a fine
job. It turns out she had only this little localized cancer. But in the