72 Becoming a Patient
angry at having to wait weeks for biopsy results. He felt he should be
treated the way he would treat a fellow physician.
I had to wait two weeks for a biopsy, then ten days for a sec-
ond opinion. If I were taking care of another physician, I would
probably Fed Ex the slides to a pathologist I knew to get a second
opinion within a couple of days. If you call someone up and say,
‘‘I really want you to look at the slides this afternoon, I’m going to
Fed Ex it to you today,’’ they’ll look at it two days later. I’m the
kind of guy who never asks for any favors. I just assumed my
doctor would hurry the process. I waited ten days. He still didn’t
have the result!
Some people requested favors more than others. To get what they wanted,
ill physicians often tried to manipulate the system—taking advantage of
their knowledge, perhaps unfairly. Dan, who had chest mets, said:
I know the system: If I keep pushing the bedside button often
enough, the nurse will get angry, and may or may not come. But if
I tell her that I’m going to spill urine all over the bed, she’s going
to come in a hurry, because that way she’s not going to have to
change the sheets.
His assertiveness could succeed, but vex his providers.
Other ill physicians used their knowledge in refusing to accept their
doctors’ excuses. They implicitly raised questions of whether there was a
limit to how much doctors should manage or manipulate the system, and if
so, when. Did they sometimes go too far? Presumably, they should not
self-doctor at the point at which it interfered with their own or others’
quality of care. But how did one know if one had reached that point? Can
one know in advance, or only afterward?
This sense of entitlement and the demands to be treated as ‘‘special’’—
as a physician, not a patient—can stem from a variety of social or psy-
chological factors, including poor self-esteem. Juan, the Latino internist
with HIV, for example, became angry when treated simply as a patient,
having been sickly for much of his earlier life. He felt ostracized as well
because of being gay and Latino.
All my life, I’ve been a patient for different things. Once I was a
physician, I did not want to be babied anymore. What frustrated
me most was getting a doctor with a paternalistic approach,