‘‘The Medical Self’’ 69
to.’’ Steven, the suburban endocrinologist with HIV, traveled to another
city for treatment, and envied patients who could get care closer to home.
Conversely, other physicians avoided treatment elsewhere, due not to
inconvenience but to desires for ‘‘VIP treatment.’’ Outside their own
institution, they might be treated as a ‘‘mere’’ patient. Eleanor’s husband
sought treatment at his own hospital so he wouldn’t lose his VIP status.
‘‘When I go to my own hospital, everybody knows who I am. When I go
somewhere else, I’m just a patient!’’
Second Opinions
‘‘When I went for a second opinion, my internist got mad,’’ Jessica, the
pediatrician with lymphoma, said. ‘‘He had a hissy-fit. As if I were his lover
and had cheated on him.’’ An aggressive stance in their own treatment
led many doctor-patients to ‘‘doctor shop’’ and pursue second opinions.
Yet, though officially sanctioned, second opinions were often mutually
difficult, as they could be seen as questioning a colleague’s expertise.
Nonetheless, many physician-patients sought second, third, fourth, and
even fifth opinions, consulting experts around the country. Unfortunately,
confusion could then arise over who was ultimately responsible for the
patient’s care. Stuart, now teaching at the university, said about treating
other ill doctors:
I saw my role as being a primary care doc; but the docs I treated as
patients, especially specialists, never really respected that. They
thought they needed someone with expertise. So it was difficult. I
would find out only later that they were seeing docs all around
town. I wondered if these patients were still my patients. That was
the biggest confusion: am I still your doctor, or are you now seeing
them over there, or just talking to them? Some didn’t really want
a doctor at all: they were just doing serial consultations.
Not surprisingly, many doctors-of-record disliked their patients’ obtaining
second opinions, implicitly challenging the first physician’s authority.
Some seemed to take it personally.
Many sick doctors felt that on principle they should simply choose a
physician they trusted, and then abide by the latter’s decisions. Jacob, the
radiologist with skin cancer, felt this logic should extend not only to
treatment, but to diagnosis as well—to interpreting one’s own radiographic
scans. ‘‘It’s not a good idea for a person to read their own X-rays. I wouldn’t