Physician As Patient (1)
Being a physician or a nurse and being sick is a unique experience that is not experienced by other people who do other jobs in their life. For this posting, I am writing my views as a physician. Nurses should be encouraged to comment here also since I would most appreciate to read their views.
Except for the most minor of clinical illnesses, physician self-diagnosis and treatment is strongly argued against by the medical profession. And that restraint on physician behavior is well taken. Physicians are humans as everyone else and have the similar personal concerns and feelings about their life and health. Well, almost similar since some physicians, perhaps early in their career, who haven’t experienced major illness may have some feelings of invincibility over disease. The difference between physicians and others is that physicians have detailed knowledge of a whole host of symptoms and diseases. This knowledge, however, may not be the most beneficial to the doctor if the doctor is attempting to evaluate the condition not of their patient but of themselves. Instead of looking for the most likely diagnoses to account for their symptoms, out of anxiety, the rare or more serious disease may be paramount in the doctors’ mind. On the other hand, the physicians, perhaps out of feelings of invincibility or fear, may simply demonstrate denial, failing to properly evaluate the significance of the symptoms. Another impediment to make a correct diagnosis is the inability to perform, in many cases, a proper self-physical examination. All of these defects in the established standards of proper medical evaluation can lead to delay in necessary treatment and perhaps worsen the outcome.
Therefore, there is a need for another physician to take over the responsibility of diagnosing and treating the ill doctor. However, functioning as such a physician is not a simple or uncomplicated exercise. Can you think of some problems that this physician might face? I will write more about this later.
But first, to get an additional view of the impact of illness on the emotions of physicians, I would like you to read an excerpt from
When Doctors Get Sick
by Howard M. Spiro, MD and Harvey N. Mandell, MD in
Annals of Internal Medicine
15 January 1998, Volume 128 Issue 2
When a doctor is sick, especially in a hospital, he or she undergoes a role reversal. Strangely, the doctor is the patient, and the familiar aspects of the hospital are unrecognizable from a stretcher. Loss of control is hardest of all for sick doctors, so used are they to the obedience of others: Sick radiologists try to read their own films, and the bed-bound physician strains to scan the bedside monitor. Sick doctors are lonely patients, isolated but on watch, vigilant against error. Caught in the double bind of wanting to be a good patient yet worrying about what can go wrong, most sick doctors watch their colleagues as closely as they fear their colleagues are watching them. It is not easy to be a doctor and a patient all at once.
..Maurice.
posted by Maurice Bernstein, M.D. @ 6:29:00 PM
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