When Doctor Becomes a Patient ?

When I became a House surgeon, I was quite arrogant, disciplinarian, tough with patients and their relations. People used to run out of the ward whenever I entered the big hall ward. One day senior staff nurse told me “please don’t scold attendants of patients. Do you know they call you “MCD ki Committee aa gayi”. You want to earn that reputation. After few days I my self lay on a trolley in the emergency department of big Govt. Hospital feeling extremely unwell. A young doctor clerked me in. He did not introduce himself by name. I said “I am a house surgeon in LNJP Hospital. He said “so what “what is your problem”. I was shaken up.

Doctor should be seen as a person, as a patient. In my residency days, I didn’t really think anything of the patients, they were just numbers in very busy OPD. Being ill taught me everything about being a doctor, it is the importance of seeing a patient as a person and not merely a condition or disease.

When was the last time you stopped and had a conversation with someone in the ward just for the sake of having a conversation? We all blame being too busy but are we really? Do we not have 10 minutes to sit down and explore someone’s worries? Having a chat can be therapeutic in itself. No examination, no diagnosing, no investigations and no prescribing; just talking and listening. And it helps!
What happens when doctors exchange the white coat for a hospital gown? Physicians learn the importance of empathy and language and gain an appreciation for the trauma of illness. During that time, we experience miscommunications, uncoordinated care, and even blatant insensitivity. My education had taught me how to treat disease. But it didn’t prepare me to treat the person. “When I finished my training, I was entirely oriented to disease.” I don’t think I appreciated how important it was to have kind and caring people at every step of the way.” “The way the treatment impacts and hijacks your life .I didn’t have full appreciation for that until it happened to me,” “I think we have to recognize that until we’re patients, we need to work to understand how our actions affect others.“It’s a lifelong learning experience.” Lack of courtesy is just one aspect of poor care. Many doctors dread illness because they are acutely aware of modern medicine’s weaknesses and limitations. Often it relates to junior doctors trying to cover up for their obvious lack of knowledge, giving an evasive answer instead of saying ‘I don’t know’ or “how can I help you”. Communication skills are at least, if not more of a concern than clinical skills. We are frail, we are humans, bad things can happen to us, just like anybody else.

Doctors find it difficult to adopt the role of a patient. They expect ‘individual therapy’ and ‘special’/V.I.P treatment, a longer appointment, consultation after regular working hours. As a patient, a doctor always uses his/her professional knowledge, experience, relationships and own position. Professional knowledge helps assess symptoms in a quicker and more reliable way, as well as decide on the type of help needed. The ‘self-diagnosis’ observed among doctors. may lead to two wrong ways of thinking about one’s disease. Firstly, it may trigger ‘catastrophic thinking’ of serious disease. Secondly, it may lead to ignoring the symptoms observed and rejecting a potential disease. Diagnosis and therapy is often delayed by professionals who experience serious medical problems since they are convinced that ‘as physicians, they are privileged (and feel a sense of casualness and often authority). Doctors tend to have a distorted image of their own disease. They often perform autodiagnosis, autotherapy and ignore physician’s advice. When choosing a doctor, they focus on their relationship with the person and not expertise of person.

Doctors are said to make the worst patients. But does becoming a patient make someone a better doctor? When doctors get sick, they discover fissures in the health system that they didn’t know existed. They learn that seemingly small annoyances they never paid attention to as doctors like long waiting times or a broken television in a hospital room really are a big deal when doctors are the patients. Even doctors who thought of themselves as compassionate recognize, they can do better once they experience life as a patient. They also become aware of how many mistakes are made, like the wrong dose of medication. One surgeon told me that the night before he underwent surgery, his surgeon told him there is a 5 percent chance you will die in the O.R. He could have said, “There’s a 95 percent chance things will go O.K.” He had been a surgeon for 30 years, and he said he’d never thought about how those two kinds of information trigger such completely different emotional responses. I’ve always thought doctors should experience some of the physical things involved in hospitalization… b-o-r-e-d-o-m, the dizziness of being moved on a trolley, sitting in a dirty wheelchair, waiting for a test and urgently needing to use the bathroom, the awkwardness of using a bedpan and trying to get clean. For starters, try lying on your kitchen floor for a couple of hours and staring up at the lights while a fan blows, cold air on your backside. Educating doctors about empathy is a useful, relatively easy thing to do. But it is no magic bullet.

A doctor’s sense of identity often is strongest in a health care setting. However, becoming a patient precipitates a dras¬tic change in authority, duty, privacy, and even attire. Everyone who is born holds dual citizenship, in the “kingdom of the well” and in the “kingdom of the sick” although we prefer to use only the good passport. The Wounded Healer in medicine and theology has special healing powers by virtue of his experience of illness. In Norway, a 2001 survey revealed that 80 percent of doctors had reported to work while sick with illnesses for which they would have advised their own patients to stay home. Two-thirds of these illnesses were considered contagious.
During my postgraduation days in emergency, one little old lady asked for a pillow, my reaction was, “What do you think I’m running here.a hotel?” On my last night as a P.G, I had leg injury following an accident. My first request in emergency – A pillow. That was a big lesson. Now I’m in my 60s, I can share my experiences. These have made me a more caring doctor.

Dr. A.K. Dewan

Director – Surgical Oncology