The Doctor Becomes The Patient: Lessons Learned From Wearing A Gown
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded into my room with a senior staff nurse in order to learn how to put in a foley catheter. As physicians, we are used to being the person in control in the healthcare setting.
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded into my room with a senior staff nurse in order to learn how to put in a foley catheter. As physicians, we are used to being the person in control in the healthcare setting. When the doctor becomes the patient, all perceived control is surrendered. No longer do we wear the “magic white coat” and wave healing hands over patients. Our daily intake and output is recorded. We are shipped all over the hospital for tests in unflattering, often risque attire. Once the transition to patient is made, there is no going back. Nothing ever seems the same.
One of the most well published experts in this area is Columbia University psychiatrist Dr Robert Kitzman. In a 2008 New York Times article, Dr Kitzman provides insight and discusses the implications of the transition from physician to patient. Dr Kitzman, after losing family in the September 11th terrorist attacks began to suffer from depression and eventually became a patient himself. Once doctors become patients, many begin to recognize major flaws in the healthcare system that had previously gone unnoticed. What may seem to us like small inconveniences (long wait times, or uncomfortable office temperatures, or outdated magazines in the waiting room) become a really big deal when YOU are the patient. The process of transition from healthcare provider to patient can be quite eye opening; in fact, I believe that time spent as a patient should be part of medical education. Even though most physicians do their very best to show compassion, provide support and empathy, it is often not enough. Sometimes we must look through the eyes of those for which we care in order to better serve their needs.
Dr Eric Manheimer who is medical director at Bellevue Hospital Center, understands this better than most. In a moving piece written in 2011, he describes his own experience becoming a cancer patient. Diagnosed with throat cancer, Dr Manheimer details his personal struggles with becoming a patient. Fear, loneliness, hopelessness, anger and loss are common. These feelings can become overwhelming to patients with chronic illness or cancers. Through his experience as a patient, Dr Manheimer has been able to inspire other physicians to become more compassionate and better understand the condition of “being a patient”. In a follow up New York Times article from July 2012 he describes how he is a much more effective doctor. Not only is he able to relate to his patients as a physician, but now he is also able to relate to them as a fellow patient. By identifying with patients and developing a better understanding of the daily struggles patients face, Dr Manheimer suggests that we can ALL be better physicians.
There are many other stories like Drs Manheimer and Kitzman. Certainly, in the big scheme of things, my appendectomy was no big deal. However, the experience of becoming a patient can and should have lasting effects on healthcare providers. The very act of becoming a patient and facing an illness forces physicians to make personal choices in testing, treatments and risks. These decisions can change the course of one’s disease. Interestingly, an article in Archives of Internal Medicine from 2011, studied how these decisions differed when a doctor recommended a therapy for themselves versus another patient. In this particular study, physicians tended to choose treatments for themselves that involved higher risk for death. It is not easy to explain this difference but one can postulate that personal beliefs and values must play a greater role when choosing treatment options for one’s self as opposed to a patient.
Patients deserve our very best. As physicians, we must remember that the people we care for are often lonely, frightened and may feel as if their world is spinning out of control. Becoming a patient can open our eyes to the challenges of the ‘patient condition”. We must strive to provide better, more compassionate care to our patients. By “wearing a gown” providers may be able to better empathize with patients and ultimately ease the pain of living with disease.