‘‘The Medical Self’’ 77
Emotionally, it’s draining. It gets to be more of a social than a
medical encounter. I like my job because I’m buffered. When peo-
ple are acutely ill, I do not see them. They’re hospitalized. Previ-
ously, if outpatients were really acutely ill, they would be in hospice
or home care, so I was able to separate from those really intense,
emotion-draining times. I do not look forward to doing it with
friends. I haven’t taken care of any friends who got really sick.
A colleague succumbing to illness can threaten the rigid structure of
doctor and patient roles, and make physicians feel vulnerable in ways that
could affect the care they provide. Some colleagues couldn’t fully ac-
knowledge Eleanor’s husband’s illness, as they were also his friends and
now his physicians.
They had tremendous difficulty accepting the fact that one of
‘‘them’’ had become one of ‘‘us.’’ He was treated where he had
worked. All his physicians were also his colleagues, and many were
friends. That played a large part in how he was managed.
These doctor-patients may in fact be expected by their physicians to
exercise a large role in treatment and follow-up, reducing the responsi-
bility of the doctor-of-record. Sally, the internist with cancer who brought
her laptop to the ICU, was in fact told to take a greater role in her own
care. Her doctor expected her to self-prescribe, ostensibly because Sally
was a fellow physician.
One doctor said they expected me, as a physician, to take more
responsibility for my own care than I did. He assumed I would
follow things more myself. He said he’d never seen pneumocystis
pneumonia in patients like me because he always puts patients on
bactrim to prevent it. I thought: Well, why didn’t you ever tell
me to do that? He assumed I’d know.
Deborah agreed. ‘‘Doctors assume that if you’re a doctor, you know
everything.’’ Yet physicians’ specialties vary widely. Scott, with the in-
fected foot, said, ‘‘I’m in an altogether different field—what the hell do
I know about feet?’’
Though doctor-patients and their physicians may agree about
treatment—whether from collusion or not—disagreements can occur, and
be thorny to negotiate. At times, ill physicians openly dissented from