When Doctors Become Patients

One could say, a walk in someone else’s shoes?

This also tells a little bit more about a patients REAL mindset at the doctor’s office. Opening up a bit more, you’ll find doctors are actually sympathetic.

An important lesson for all medical professionals, not just doctors. It’s unfortunate that we don’t have an easy opportunity to “interview” medical professionals before committing to them, as we do bosses and partners and the like.

Everyone who serves others would do well to remember what it feels like to be in a position of need, and that a bit of compassion can make a tremendous difference.

I almost wonder if part of medical training might involve turning doctors into patients? I have in mind medications like Tapazole, which blocks thyroid hormones to simulate hypothyroidism (a fairly common malady) or Cytomel to cause hyperthyroidism? I’m sure that someone with medical knowledge could come up with many more ideas.

Also, as part of training, do physicians undergo diagnostic procedures that can be unpleasant, like mammograms or colonoscopies? If not, it might lead to some of the understanding that the article describes.

Of course, there are certain to be ethical issues here, but I’d like to think that it is worthy of a least a bit of discussion.

Sometimes it’s hard to walk that delicate line of empathy and being able to stick an NG tube in someone’s nose, or a needle in a baby’s arm, just imagining how uncomfortable it must be.

At least it still is for me as a student. I think a lot of medical professionals distance themselves in order to be able to do what we do to people, for people, to help them. It’s a weird kind of balance that seems almost impossible to master.

As a patient I had a doctor who couldn’t look me in the eye when my jaw was swollen shut. I thought he didn’t care about me. That is, until I got better and he looked so relieved and happy, then I knew that he just cared too much to be there for me all the way.

It’s not easy seeing suffering all the time. Most of the time I think doctors care a lot, they are just human too and don’t always handle it in the best way.

As a new intern, I’d be standing in a room full of very sick people with endless demands. I was quite cocky, and felt very important and put upon, running this complicated show. When one little old lady asked for a pillow (we didn’t even have them), my reaction was, “What do you think I’m running here..a hotel?” (Fortunately I didn’t say what I was thinking!). On my last night as an intern, I had an anaphylactic reaction, went unconscious, and woke up on a gurney in that same room. My first request? A pillow. That was a big lesson. Now I’m in my 50s, and have had many procedures and hospitalizations, which is helpful because I can share that with patients. It has made me a more caring doctor.

I am writing a masters essay for a degree in bioethics. It considers the often unconscious assumptions, attitudes and biases health professionals hold toward patients with disabilities and their affect on care given and received. Empathy, rather than pity or indifference, requires awareness. This book will go as long way toward increasing it, especially important for those with disabilities because we are frequent, yet underserved, consumers of healthcare. In a society compelled to consider practical medical ethics issues like quality of life and just resource allocation, empathy can go a long way towards personalizing an often daunting “system.”

I have been a pain management physician for twenty-two years, twenty of which were spent as a chronic pain patient. My experience as a patient ranged from bad to abysmal; I carry this with me to work each day as surely as any piece of equipment. At all times I at least attempt to give the kind of treatment that I would have wanted, personally, in my own darkest hours. Being a patient – and a father of one – was my own personal destiny, and one in which the development of empathy and spirituality was the only way to make sense of human misfortune and misery. It has changed my life utterly: surely personally and – I would like to think – professionally.

Douglas Ashendorf, M.D.

I think that’s why ‘witch doctors’ may have had a better education in illness than conventional doctors.

I can’t imagine why a person would be a psychiatrist without having experienced depression or other psychiatric symptoms. How could he understand what his patient’s were going through?

It’s interesting that a lot of the posts have mentioned aspects of care they received as patients that they formerly, as physicians, would “dismiss as unrelated to the outcome of the procedure” (to quote post #3)–things such as having a warm blanket laid over you before going into a frigid operating room, or securing a pillow when you’re flat on your back on a stretcher.

And yet not one of these posts has acknowledged that these seemingly “unimportant” gestures are the art and science of quality nursing nursing care. We know that the OR is kept at a colder temperature level so that the surgeons and nurses working under intense pressure and a lot of layers can be more comfortable. That’s why RNs use warming blankets on patients undergoing procedures.

We also know that people laid out in supine positions without a pillow can raise blood pressure and exacerbate orthopnea and increase risk for aspiration pneumonia, so we encourage side-lying positions with plenty of pillows to prop around the patient’s back and head.

So, please, feel free to post more about the wonderful nursing care you received when you were a patient, and how you now have a better appreciation for the nursing profession and all we do. The fact that you left that part out just perpetuates the popular myth that the “important” care provided in hospitals is that given by physicians, when we know that you know that it isn’t even a little bit true.

No kidding, doctors ignore fatigue. It took me 35 years and probably as many doctors to be diagnosed with narcolepsy. I was a textbook case–one of those rare people who had all the symptoms. I had been to several neurologists, not one of whom ever asked about my sleep or other symptoms relating to narcolepsy. Narcolepsy is as common as MS or Parkinson’s disease, but its cardinal symptom–excessive daytime sleepiness–is one that doctors dismiss.

Physicians are told to “empathize.” But it is really quite difficult.

When trying to get the history, I often explain that I am not in their body, and I need their words (and anything else) to try to understand what they experience(d). [The time frame may be especially important in diagnosis.] And, finding those words can be very difficult. (I was learning this skill of interviewing and doing physical examinations (PDog, in the vernacular) when I sought help about something as mundane as a (common) knee problem. Just thinking about how to describe this ailment according to the 7 standard parameters was daunting. But, as I also explain to patients, the retelling of the story also helps as some other aspect of the experience comes out or is recalled. Depending upon the relationship, the receiving end, this telling can also be aggravating or therapeutic.

As for training: my psychiatry med school rotation had almost daily seminars using literature. This can give a better sense of what the patient experiences. These were true wordsmiths, and often (as Styron) writing from experience. In some respects, that can be the closest I will get to actually experiencing what the patient may experience. But it is invaluable. Maybe more so than some of the “rounds” on the inpatient psychiatric unit.

With the time pressures imposed by the limited/miniscule insurance reimbursements, the physician too often want the Joe Friday story that reads like a board question – “A 44-year-old woman is evaluated for a 2-month history of increasing joint pain and swelling of the bilateral second and third metacarpophalangeal joints, wrists, metatarsophalangeal joints, and left ankle. Her symptoms are worse in the morning. She also has morning stiffness that lasts approximately 3 hours after awakening. She takes ibuprofen as needed with minimal relief. She has a 6-year history of a chronic rash limited to her knees but has never sought medical care for this condition.” The “payoff” for true empathy is in the doctor-patient relationship, not in financial terms (except via reputation.)

The current system treats the medical encounter, the doctor-patient relationship, as no different than your check out from the grocery store – as a commodity, each identical to the next, with throughput as the (only) parameter that counts. We are viewed as check lists, not experiences. (This applies to nurses as well as physicians. Nurses, especially in hospitals, now have a greater duty to assure that the JCAHO parameters are checked off, not that they minister to the patient. EMRs also enhance this: I note “agitated” is checked for overnight shift, not that the patient was calling for a family member and tried to get out of bed without assist.)

I can’t tell you how many times I have said, “I bet that doctor would not do this.” Yes! I think physicians should undergo some experiences…for one, facedown recovery. After some eye operations, a gas bubble is inserted and you have to keep your face parallel to the floor for up to two weeks. They told me this had to be 24 hrs a day. The implication was that if my head came up, it would ruin this horrifying and disgusting surgery. I sent my frisky dog away and he was killed by a car. Later, I learned most top retina surgeons let you look up 5 mins of every hour. If they made doctors try a week of facedown, this would not have happened. This is just one example. I could name a dozen more. As for the nurse, who said we should really be talking about the great care nurses and their staffs give, I have had this go both ways. I have been yelled at by nurses! And I have had some who truly were angels who sneaked in.