‘‘The Medical Self’’ 75
bring some labs.’’ Heightened bureaucratic demands on physicians fur-
thered these practices, even if the latter were problematic.
Conversely, to avoid imposing on others, some physicians vowed never
to ask a friend to treat them. Paul, the internist with HIV who lost a job
offer, said, ‘‘If I needed a physician, I would probably use a friend’s new
office partner. He’s not a friend. I would just hate to burden a friend with
having to take care of me.’’
Given these potential conflicts and pitfalls, others sought care from
colleagues/friends, but tried to set limits. Still, the potential blending and
confusion of roles could present problems. For example, some enlisted
friends to provide certain aspects of care but not others. Kurt, who had
used crack and now had HIV, referred to himself as the ‘‘dictator of my
medical care,’’ and picked a doctor he knew. But Kurt drew firm param-
eters concerning what he would and would not do.
Occasionally, I would have my nurse draw my blood, and I would
check my T-cells every six months. I did my own stuff, off the
record. My doctor chose the meds I wanted. If he hadn’t, I would
have told him. If he wouldn’t prescribe them, I would have gone to
someone else. If I develop fever or night sweats, I would see him.
But for my anti-viral management, I know as much as anybody.
Since I know what drugs I’ve been on, I’m in a better position to
choose them.
Yet as to ‘‘being in a better position,’’ Kurt may be rationalizing here,
since alternatively, he could tell his doctors what meds he had tried.
Based on their recognition of their own tendency to want to remain
in control as patients, and sensing the potential problems, a few physi-
cians purposefully chose physicians who would be firm and objective, and
challenge any self-doctoring. Frank, the surgeon who had an MI in the OR,
for example, feared he would undermine his own treatment, an