‘‘The Medical Self’’ 81
physician’’—clinical, detached, in control. He could acknowledge
fear, talk about what he couldn’t say to his physician-friends. To
them, he couldn’t say, ‘‘I’m tired.’’ They’d say, ‘‘Of course! You
have cancer! You understand the process. Why is that surprising?’’
as opposed to ‘‘Yeah, it must really be tough.’’
Colleagues supported him as a fellow physician, but not as a patient.
For some physician-patients, only debilitating illness or cognitive decline
halted this mutual denial.
Even at the end, Eleanor’s husband entered the role of patient only
with reluctance. To alter such a ‘‘denial system’’—as opposed to a support
system—could be difficult. A social system can support particular beliefs
about a diagnosis, even if these are maladaptive. Eleanor tried to confront
her husband’s denial, but couldn’t.
I’d say to him, ‘‘You are dying. I really need to know what you
want, and don’t want, done.’’ The conversation would get turned
on and off, depending on his mood. It was generally ‘‘We’ve
discussed this before.’’ But we really hadn’t. Many times when I’d
raise the subject, he would just literally turn the TV on, to head
off the conversation.
In sum, in confronting diagnoses, treatments, and prognoses, these doc-
tors had to decide whether and to what degree to let themselves be patients
versus ‘‘remain in control’’ and self-doctor. They tended to be patients
if they had comparatively less experience treating their own diagnoses.
Others used their ‘‘insider status’’ to ‘‘manage the system’’ and access or
forgo procedures. Controversy swirled most around self-prescribing, from
the innocuous to the potentially problematic. Some rationalized the
practice, while others tried to limit it. They self-doctored because they
could, did not want to depend on others, were obsessive by nature, or de-
nied or had difficulty accepting their illness.
Self-doctoring increased due to deeply ingrained professional identi-
ties and to managed care’s obstacles in accessing care, but at times de-
creased when the disease grew more severe. Some of these individuals
self-doctored without thinking of themselves as doing so. Others did not
discuss their self-treatment with their physicians-of-record, though med-
ical problems could then be overlooked. At times, sick doctors and their
physicians attempted to impose ground rules or constraints on self-
doctoring, but these efforts often failed.