68 Becoming a Patient
But how does one get a reputation? Presumably he or she is honest and honorable— knowing his / her limits, admitting errors. But those are surface phenomena that don’ t make a good doctor.
Questions therefore emerged as to the nature and notion of‘‘ reputation’’ itself. These physicians realized more than before the limitations of assumptions about such assessments. Moreover, if they encountered difficulties judging a colleague’ s shortcomings, lay patients must invariably face even greater barriers. Nonphysician patients may be unable to judge their doctors’ competence or limitations adequately.
The patient doesn’ t know whether technically docs are any good. So‘‘ the good doctor’’ is to some extent a myth. We don’ t do outcome studies. The state is beginning to, but mostly in surgery: a gallbladder operation is more or less a gallbladder operation. You can compare them. But in medicine, everything’ s mixed up.
Getting Treatment Elsewhere
These ill doctors had to decide, too, whether to find a physician and receive treatment within their own hospital, or elsewhere. Some obtained their care relatively far away, in other cities, states, or institutions, rather than their own, to protect privacy and avoid being seen differently. Boundary violations occurred when colleagues, chairmen, and supervisors came by to visit, read, and comment on ill physicians’ medical charts, often with little sensitivity to the implicit impropriety.
Many traveled elsewhere for treatment because they feared discrimination— even by‘‘ enlightened’’ colleagues— whether subtle and implicit, or more drastic. Sally said:
I didn’ t want my diagnosis to be anyone’ s business around here. It’ s a feeling I subsequently confirmed: no matter how enlightened people are, they put you in a different category.
Stigmatization may be unconscious as well as conscious.
With HIV, state reporting laws further impelled physicians to seek outof-state treatment. George, an internist with HIV who served on government committees designing policies concerning HIV-infected physicians, said,‘‘ My state has name-reporting, so patients with money go to the next state to be tested or treated. It’ s unfair for people who can’ t afford