Among the many urban myths about Medicine is the one that says doctors don’t get sick – we even believe it ourselves, we are infallible, we treat illness, we don’t get it. Of course, being human we are as much prone to illness as anyone else. So how do we care for ourselves when the doctor is the patient?
When I took time off to have radiotherapy for breast cancer, I could count on the fingers of one hand how many days I had taken off previously during my entire career. This is not to say I had not been ill, rather that, like many doctors, I worked through it. Neither was I healthier than most of my patients, just that I somehow believed taking days off and asking others to do my work was unfair. Nor was it that I did not feel guilty for taking time off on this particular occasion, rather that I recognised that perhaps pushing through and stress may have contributed to the illness in the beginning.
Despite our knowledge and experience, we may well put off seeking help ourselves. It is difficult for us to accept that we may be ill ourselves and that it may affect our ability to work and this may lead to late presentations for help, delayed diagnosis, and in truth we may not have made the right diagnosis.
I have to admit, with a little embarrassment, to misdiagnosing my own appendicitis after 40 years of medicine. It was such a common presentation when we were housemen, and it was our job to take them out and then I never really believed in “grumbling appendixes”. In my sixties I developed recurrent episodes of severe right iliac fossa pain which resolved within 24 hours. Like other doctors, I down played my symptoms and when it was better, put it out of my mind. Even when the pain persisted and became more severe I did not believe it could be appendicitis because it was not severe enough and anyway who gets appendicitis in their sixties?
Do doctors make good patients?
And do we ourselves make good patients? It’s not much fun being a patient, it feels very disempowering even when you believe you have the best of medical care. Waiting for doctors, for theatre, waiting for results, for Godot, teaches you why we call our clients patients.
For clinicians, treating their own colleagues can be difficult. When treating a colleague who is knowledgeable about medicine and all that can go wrong with medical care, it is important for both that the physician treats the doctor as they would any other patient, and the doctor, who is also patient, accepts that in this situation they are on the receiving end of medical care.
In retrospect being “the patient” was a gift for me, as a doctor and as an educator.
While I could not recommend that all my students become patients themselves, it is invaluable to learn what it feels like to be on the receiving end of clinical care and to understand how patients would really like to be treated. It was wonderful to be able to trust the clinicians who treated me and to surrender into their care.
Physicians who have experienced severe illness or trauma often experience an epiphany in the way they approach their role as physician after they have recovered, making significant changes in both their careers and in their lives.
It is perhaps when we are facing terminal illness that we need to put our greatest trust in Medicine, but also in our own knowing to make informed and caring choices for ourselves. It was said in the past that few doctors would themselves take chemotherapy. When there is a choice we choose not to undergo futile treatment, knowing that death under those circumstances is inevitable. Most of us want to live full and meaningful lives and if treatment offered hope and the statistics were good we would undertake therapy, but we are familiar with death and dying, and know when it cannot be avoided.
Being sick yourself is probably the most important time for a doctor to practise self-care. Here are some tips:
- Seek your own medical care. Remember the old adage – the physician who diagnoses himself is a foolish one! Treat yourself as you would advise your patients to do, seek help in a timely fashion, don’t rely on self-diagnosis and avoid self-prescribing.
- Choose the best care team for you. Remember that you are deserving of the best care, just as you would choose for your own patients. Choose clinicians and other practitioners you trust, who have expertise in their field and whom you know will honour and care about you. Choose friends and family members in whom you can honestly confide and whom you can trust to support you and your family in the ways you know you need.
- Allow yourself to be the patient. Make sure you are well informed and are able to make clear decisions about your own health care. There may be times you do not agree with the diagnosis or treatment – choose a clinician who encourages these discussions. When necessary, trust in the medical system knowing it will do its best for you – this is what we ask of our patients.
- Allow yourself time to rest and recover. Income protection and sickness insurance assist us to take the time off we need and if required support us to find locums to fill in for us.
- Recognise that just like our patients, we are likely to have a psychological reaction to illness particularly if it is severe or causes chronic pain. Remember that there are times we do not feel strong, when we feel grief and fear about illness. Allow this in yourself and seek the support you need.
- Allow yourself to be treated with tender loving care. This is what we know our patients need and it is what we ourselves need to heal.
- Allow illness to be a time for reflection – on how we practise medicine and on what patients need of their physicians, but also on how you have been living your life and what you have expected of yourself. Maybe it is a crossroads offering change, a more loving and caring way of being in all that you do.
When the doctor becomes the patient, we have an opportunity to care for ourselves deeply, perhaps for the first time in our lives, and we can all learn from this experience and then bring this knowing to our own lives and to the care of all our patients thereafter.