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
5 comments
5 Comments:
If you are still reading any comments to this entry, I am an RN. I had a baby in the hospital in Aug, and would like to talk about that experience specifically. I was not in the hospital by choice. I had planned a 5th home birth, but was risked out at 36 weeks for anemia. I immediately created a birth plan that mostly involved leaving me alone, and went over it line by line with both my doctor and the nurse manager of L&D. My wishes were followed and I had a wonderful birth, though I would still choose a home birth. I believe being a nurse had a huge impact on my experience for several reasons. I knew the real risks and benefits of every potential intervention, so I knew in what circumstances I would and would not accept them. That is incredibly unusual among laboring women. I knew the doctors in my area professionally, so I was able to choose a doctor who was competent and respected my philosophy of birth. I knew the staff of the L&D unit professionally, so I was given more leeway with less fuss. I knew exactly how much power the hospital and doctor had, so I was free to refuse any unwanted procedures. (the intimidation factor is nil) My doctor and the nurses also knew me professionally, which changed me from a potentially litigious stranger asking to forego standard procedures to someone they trusted a)to know when an intervention was necessary and b)not to sue for unpreventable events.
I think as a nurse I am more likely to question my physician, more likely to research on my own and meds or procedures advised, and more likely to make decisions based on my own (or my family's) interests rather than the approval of an authority figure.
5in9years
As you point out, there is definite advantages to being a medical professional and being a patient and you apparently made good use of your medical understanding and perhaps also some clout. The question to consider, though, is whether your doctors would have the courage (if that is the right word) to argue against your views, if it was clinically important, with as much fervor as they would with a casual patient with whom they were not so well acquainted. This is one of the problems associated with so called "VIP" treatment. ..Maurice.
It's been my experience that they do. My doctor in this situation did request a couple of minor interventions that I felt were unnecessary, and I agreed to them for his comfort, since there was some validity to his argument. (I still think they were unnecessary) That is probably different for nurses than doctors, though, since few doctors consider nurses to be colleagues in the full sense of the word. IME, doctors don't really take nurses' knowledge or even intelligence seriously enough to impede their arguing a different view.
5in9years
When I am a patient, I try not to let the nurses and techs caring for me know that I am a nurse. It seems to intimidate some of them.
I only choose physicians who are willing to treat me as if I know little or nothing more than the rest of their patients. I'm a NICU nurse. I know the vocabulary, I read a lot, and I'm pretty good with Google, but I still want things explained. Besides, when you're sick or under stress from a new diagnosis, you don't necessarily process information as well as the average lay person, much less better.
In return, if a nurse or physician's baby ends up in my care, I won't presume that they know everything -- not even my Maternal Child director many years ago. Exhaustion and postpartum hormones had affected her ability to access her knowledge base.
I had an interesting experience a few years ago when I developed a paronychia. I knew what it was, and I knew what antibiotic was needed based on the resistance profile in our area. I was about to call in the prescription for myself when I had an attack of conscience. How was I to set an example for students/residents if I don't practice what I preach?
So I made an appointment at the urgent care clinic of our university's internal medicine practice. I was asked if I wanted to see a resident, or wait several hours to see an attending. Since I was in a rush, I chose the resident (actually, an intern in this case)
The poor guy was TERRIFIED at having to treat an attending. I felt really bad for him, and told him to just do whatever he would do for other patients. Still, I could see he was uncomfortable.
He did indeed prescribe the same antibiotic as the one I had been ready to prescribe to myself. After completing the course, everything was fine, except that I developed a yeast infection as a result of the antibiotic use.
I phoned in the diflucan myself. There are some things I will just not go into with the house staff. :-)
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