“How will you manage this brain tumour, if you or your wife was the patient?”
This query presupposed that Mark Twain's observation of “there are many ways to skin a cat” extends to medicine as well. After all, healthcare is not mathematics. Medicine is not black or white. It is various shades of grey with different options offered to the patient and the doctor for identical problems.
Does the decision-making algorithm differ when the doctor is the patient? This provocative question, from my teacher 37 years ago, exasperated me. My knee-jerk reaction was one of resentment. Youth is rebellious. Why should I get a brain tumour? How mean? It took years for me to realise that the Old Man was correct, after all. Millennia ago, did not Mathew 7.12 enunciate “Do unto others, as you would have others to do unto you?” Should this not be the golden rule of treatment?
Reality dawned much later, that in the real world, “All men are equal, but some are more equal than others” and that doctors are no exemption. The doctor-patient supposedly should get special treatment: an insider's knowledge, immediate access to top specialists, built-in second opinions, no waiting, no insane bureaucratic battles and no loss of identity or dignity, not being known as “the craniotomy in Room 402.”
Alas! It doesn't usually work that way. While doctors should be in a better position than others to have an earlier diagnosis, it often does not happen. The doctor-turned patient is a distinct species oblivious of symptoms and signs. An editorial in The Lancet (1: 351, Feb. 16, 1929) on the doctor as a patient, discusses the difficulties in treating a too well-informed patient — a sick, self-treating doctor is never a good patient. Obviously, the “doc as a patient” problem has been longstanding and universal. There is always an extreme reluctance on the part of any doctor to admit that he/she could be a patient (“---- my headache due to a brain tumour?, come on, I have treated thousands of headaches ----”).
Nature has the last laugh, for some inexplicable reason it is neurologists who develop parkinsonism, surgical oncologists who get cancer, cardiac surgeons who require a bypass, intensivists who are admitted to ICUs. It has been my misfortune to witness this every now and then. What goes on in their minds, I wonder.
I recollect using double negatives and pointing out that statistics of survival, give only the mean value, that you could very well be the outlier outside the bell curve, etc., hopelessly trying to reassure my very sick teacher. He must have thought “Well, I taught him.” A doctor should be treated as a patient, not as a doctor, for better results.
The Archives of Internal Medicine published a much-discussed study that revealed that doctors might recommend different treatments for their patients, than they would for themselves. Potentially, life-saving treatments with side-effects were more for patients than for doctors. Several doctors use patient authored websites to get practical advice. After all, one has to be a patient to understand what a disease means. One cannot learn swimming through a postal course. Who better to empathise with a doctor patient than a fellow patient, not a fellow doctor? An e-patient transcends the white coat. The reversal of roles is so profound – the omniscient health care provider is now a health care receiver, from saving life to running a risk of losing life, becoming a mere mortal!
It is impossible for Mr. Know it All to accept this. A patient becoming a doctor is different from a sagacious doctor turning into a patient. Resigned acceptance, anger, sadness, and why me? These are all the reactions. Doctors, let us wake up, we are no longer occupying the lofty pedestal, supposedly given to us in the earlier centuries. Let us open our mind as we open our eyes. Let us look at life from the other side of the bed rail; when sick let us be a patient, we will certainly become better doctors. Health care is much more than cutting and stitching.
Epilogue: How do I react when my patient enquires about the pain and limp in my foot, a consequence of ignoring hairline fractures in the toes – Well this health enquiry is not billable, unlike my enquiry!
(The author is a telemedicine specialist and Chennai-based neurosurgeon. Email: drganapathy@apollo hospitals. com)