82 Becoming a Patient
For themselves, many doctors took more aggressive approaches than they
would for their patients, leaving no stone unturned, and at times experi-
menting on themselves. For themselves, they accepted relatively higher
risks of harm. Often, this aggressiveness succeeded, but such double stan-
dards raised disturbing questions: whether and when protecting patients
interferes with accessing beneficial treatments for them. The success of such
aggressive treatment challenges the cautious conservatism dictated by mal-
practice concerns.
Many doctors did not practice what they preached, particularly re-
garding diet, treatment adherence, and preventive care. Changing un-
healthy behavior proved hard. These physicians tended to feel invulnerable,
and the demands of medical training facilitated poor health behavior.
Knowledge of preventive behaviors alone was not enough to instill them.
This resistance among physicians presents challenges for interventions
aimed at improving health through prevention among lay patients as well.
Prognostication, particularly of one’s own demise and death, was es-
pecially difficult, and led to self-distancing, viewing one’s self as a patient
from the standpoint of one’s ‘‘medical self’’ or ‘‘medical gaze.’’
In choosing their own doctors, these men and women revealed a wide
range of ‘‘tastes’’ and ‘‘styles’’—generally, but not always, preferring min-
imalists to obsessive overdoers. They also sought to balance good bed-
side manner with technical skill. Most favored marginally more of the
former over the latter. They now witnessed, too, how much colleagues’
clinical reputations could fall short. Still, particularly in certain surgical
fields, a few of these physicians valued colleagues’ technical prowess over
obnoxious behavior. These ill physicians had to decide, too, where to get
treatment—at one’s own institution versus elsewhere—balancing privacy
and potential stigma versus convenience and VIP care.
Frequently, these doctors shopped for additional opinions, though
doing so rankled other physicians who felt that this behavior implied
criticism of colleagues, which was taboo. Second opinions can be vital.
Their rate and efficacy have been examined with regard to invasive pro-
cedures, as means of avoiding unnecessary surgery (5, 6), and obtaining
additional information about breast cancer trea tment (7). But many as-
pects of second opinions have not been explored: barriers, facilitators,
norms, and attitudes among physicians and patients, and the ways first and
second opinions vary. Lay patients, no doubt, also find that their doctors
resist these potential critiques.