‘‘ The Medical Self’’ 73
hearing me using technical language, and still going back to layman’ s terms, and dumb, inaccurate layman explanations. I would correct him:‘‘ I am a physician! You need to be a little more precise.’’ Some doctors got up and said,‘‘ Then find yourself another physician.’’ Fine. Others said,‘‘ I’ m sorry. I didn’ t remember. I was just going on automatic mode, and gave you the little spiel I give everybody.’’
His personal history made Juan particularly sensitive to slights. His remarks underlined how much doctors had‘‘ automatic spiels’’ they gave without considering patients’ individual characteristics. Doctors saved time and energy through such rote speeches, but seemed unaware of such habits and the costs involved.
Problems with VIP Treatment
‘‘ The worst care I ever saw was for a multibillionaire’ s son,’’ Harry, the war refugee, said. In many ways, VIP treatment could be suboptimal. Entitlement can simply be unrealistic— impractical or unproductive— and anger health care providers. Yet to counter these ill physicians’ expectations can be hard. Harry described how VIP care provided the son of one of the richest men in the world the worst possible treatment.
This son had a cranial pharingioma, and was under the care of the five chiefs of neurosurgery here and at the four other medical schools around the city. Nothing got done. I was his medical consultant. They disagreed, and the father would not relinquish control and say,‘‘ You’ re the doctor: do what’ s right.’’ He thought he was doing the best for his child by having the five chiefs be quasi-joint physicians. That was the worst thing you could do.
Such VIP treatment can interfere with the chain of command, paralyzing processes of decision-making and care. VIP treatment can also prompt demands for information that then overload the patient. Scott, the internist with an infected foot, said,‘‘ Doctor-patients with entitlement want you to report daily on their baby’ s every bowel movement. That’ s just unrealistic:‘ You don’ t really want to know that.’’’ Doctors facing illness in themselves or a loved one may believe that more information is better, but this belief may not be entirely correct.