The Bad Patient

An excellent essay on the US medical system, r/illnessfakers, chronic illnesses, alternative medicine, etc.

Key quote:

Illness is a matter of testimony. You tell somebody else — generally, somebody who has more degrees than you — how you feel, and they, ideally, have the ability to recognize in your testimony something you lack the expertise to identify. And often the body itself testifies: a doctor runs a scan or tests your blood and gets an answer. You have information, and the doctors have understanding. But this dynamic, in practice, is rarely so simple. Illness is also a social negotiation between what you have to say and what your doctor is willing to hear — and the diagnosis that results from this dynamic isn’t exactly your illness, but a mutually agreed-upon fiction. 

As the only person in a position to testify about how he or she feels, the patient is the victim, neutral witness, and scene of the crime. Which role to play and when and how, what to emphasize and what to downplay — these are all decisions with real consequences. Something I’ve been amused to note, when reading through my own medical records, is that whenever I’ve answered “no” to a doctor’s question, what’s been written down is “patient denies.” This is understandable — people lie, or misunderstand a question, or remember something later — but it makes clear that a patient’s testimony is always somewhat suspect.

Sitting and talking to a doctor, a patient might make a point of maintaining a calm affect, downplaying or dismissing symptoms, just to get the feeling of being on the same team as the doctor: Yeah, I don’t trust her either — that whiner. This behavior is the instinctual and rational response to somebody who has a lot of power to help or hurt. Patients establish that they are — or can be — good, rational, and believable. Divided internally, the sick person gangs up on an imagined, pathetic version of himself: the bad patient. But the bad patient is also the one who is sick: he carries all the stigma and the suffering. It’s this bifurcation, the way in which sick people must learn to manipulate doctors, that makes them fakers — even of illnesses they legitimately have.