‘‘The Medical Self’’ 67
I said to him later, ‘‘We did a good job.’’ He said, ‘‘There’s no ‘we.’
It’s just me!’’ He has an aura of being really smart, but he’s not
systematic. Out of his stubbornness, he did a couple of dumb
things. He put me on a drug that dropped all my counts. He didn’t
recognize it. He was hell-bent that he knew how to do this. I put up
with him, but it became intolerable, and ultimately dangerous.
Here, as elsewhere, these doctors revealed discrepancies between
colleagues’ reputations and technical competencies. Department chairs,
too, may have impressive reputations, but not the most up-to-date
‘‘hands-on’’ experience. Herb, the neonatologist with an MI, said:
My chairman said, ‘‘The chairman of cardiology is willing to treat
you.’’ I had no interest in that. I wanted a ‘‘bread and butter’’
doctor who has more day-to-day experience. When was the last
time the chairman handled a basic MI? Probably a long time ago.
These ill doctors became more aware of the difficulties and limitations
involved in assessing colleagues’ abilities. Harry, the internist and war
refugee, said:
You don’t know how good a doctor is—whether from hearsay or
reputation. You have to be their patient to find out—in terms of
caring, empathy, and understanding. None of these qualities are
described by the conventional measures of excellence: faculty po-
sition, number of referrals, size of practice. Well-reputed people,
when I was their patient, were technically fine, but that was it.
They had very little interest in emotional, psychological, empathic,
or relationship factors. I thought I knew an internship mate of
mine well. I’d seen him work. I went to him, and he was willing to
treat me over the phone or in the hallway! That’s where you make
your biggest mistakes.
This gap between reputation and performance can be shocking. Harry
continued, pointing out the importance not only of personal and technical
skills, but of integrity as well, and reflecting on the underlying causes of
these discrepancies.
I was startled by my own discovery that I didn’t really know who
they were. Everybody says they’re wonderful, so they must be
wonderful. But what is that based on? Presumably manner, kind
voice, apparent interest, and enough time to listen and respond.