74 Becoming a Patient
Colleague-Physician-Friend: Collusions and ‘‘Denial Systems’’
Though they were not self-doctoring, some doctors came close by select-
ing physicians whom they knew well, in order to negotiate for better
treatment. Roger, a surgeon who became suicidal when diagnosed with
HIV, said he knew which physicians could work with his ‘‘boundaries’’—
specifically, his abhorrence of hospitalization.
I state my boundaries up front: you’re not going to hospitalize me
for pneumonia, and I’m not going to go on a ventilator. I left a
physician because he wanted to put me in the ICU!
On the other hand, others chose a doctor-friend who would consult
only if they were doing well. Walter said about his physician:
We’ve known each other since internship. He said that if it looked
like I was going to die, he didn’t want to be my doctor. For that,
he wanted to be my friend.
Over time, as patients’ conditions worsened, these boundary distinctions
could be hard to maintain.
Many chose good friends as physicians in order to have a ‘‘physician-
of-record,’’ while still controlling their own care. Juan, the internist
with HIV, and a colleague/friend wrote prescriptions for each other.
Juan termed this practice ‘‘incestuous’’ and ‘‘not kosher,’’ suggesting de-
grees and gradations of inappropriate or unethical behavior. Each was
physician/friend/patient to the other.
My current ‘‘physician-of-record’’ is a former officemate. I used to
be his physician. When I need something, I just call him and get
it. If I want something checked out, most of the time I know what
it is, and just get it confirmed. Because I know what I’m dealing
with—what the risks are.
Juan’s phrase ‘‘not kosher’’ suggests that these behaviors are not, strictly
speaking, unethical, but not fully appropriate either.
Over decades, Albert, who had an MI on the highway, reported that
colleagues and he ‘‘routinely signed each other’s forms for yearly physi-
cals’’ required by some hospitals. Friends completed disability forms, too,
for each other. Albert continued, ‘‘I’ve had a friend who is a doctor fill out
my disability form forever as a favor. I see him every three months and