When the Doc Becomes the Patient

I ran across something in the NY Times that caught my eye the other day. It was an article titled, “Do Patients Have the Toughest Job in Medicine?” by NYT writer, Tara Parker-Pope, and it referenced a blog post by an MD, “Doctor D“, who blogs about the doctor-patient experience. As a blogging doc, Dr. D gives his suggestions, help and thoughts on the medical community from his perspective as a physician. However, he recently had the roles reversed when he broke his leg and suddenly found himself on the other side of the appointment. He came away with some interesting insights–seven to be exact. I won’t comment on all of them, but I did find a few pretty insightful and interesting.

Here’s part of what he had to say:

Being the patient Is the hardest job In medicine. We doctors think we have difficult work. We have to slave our asses off for years in school. We are expected to be perfect and heroic while working with huge uncertainty. We try to protect your health, comfort, and life, while you patients just lay back and get taken care of.

Lying here isn’t as relaxing as overworked docs think it is.

Just a few days as a hospital patient cleared my mind of any misconceptions. Abject helplessness combined with severe pain trumps everything. And helplessness is far worse than pain. Dr. D had never done anything as a doctor that caused more stress than allowing myself to be put to sleep for a major operation with a surgeon I had only spoken to for 30 seconds.

Why would being a patient be the hardest job in medicine? Perhaps because his physician wasn’t listening to him, which, unfortunately, is common in today’s medical structure. Doctors are overworked, understaffed, and they are having to battle insurance carriers on every little thing just to get paid. As a result, there are some publicly traded H.M.O.s that restrict the time a physician can spend with a patient to seven minutes. SEVEN MINUTES! What could you possibly hope to find, and how could you possibly expect to build rapport with your patients in seven minutes? What a joke. You think your physician has time to listen to you? Not if he wants to get paid. Dr. D admitted feeling helpless and stressed after speaking with is physician for 30 seconds prior to surgery. I’m sure seven minutes would have seemed like a gift from Heaven!

Dr. D also has a new appreciation for the pain scale.

There is much more to pain than a number. Doctor D has written a lot on pain scoring, so I attempted to rate my own pain as a matter of curiosity. I have a good imagination for what 10 out of 10 pain would feel like, so I gave the feeling of multiple shattered bones crunching whenever my leg moved a 7, which made it the most intense pain I’ve ever felt, but I could totally handle the excruciating acute pain.

The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won’t leave can make a person much more miserable than 10 out of 10.

I actually appreciate what Dr. D says there. It’s always a good reminder to get inside the heads of our patients/clients. As most of you know, I came to Egoscue about 15 years ago with an extremely painful lumbar disc bulge. I’ve been pain free ever since with the exception of three years ago when I had severe SI joint pain. That was a huge learning experience for me. It taught me that I can’t stop practicing what I preach to my clients daily. It also taught me more about my own body which has improved my therapy exponentially.

He also touches on pain meds, which I found very interesting.

Narcotics suck. I’ve seen a lot of nice people get addicted to opiate pain medicines…

I am so happy to be off those things. As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.

Dr. D, THANK YOU for taking meds. The reason I’m thanking you is that now you know, first hand, how big of a crap shoot prescribing meds to your patients is. You said it yourself that your best pain meds are “inconsistent and imperfect,” and I would hope and pray that it would change your prescribing patterns, but I’m doubtful it will. My fear is that you’ll stay focused on the symptom instead of looking for the cause. It’s too bad, because you could save your patients a LOT of time, money and energy if you changed your focus simply by a degree or two in another direction and became more cause-focused.

I’m glad that, just like me a few years ago with my SI joint pain, Dr. D’s ego took a little hit.

Being disabled can really crush an ego. Regular visitors to The Clinic of Doctor-Patient Relational Awesomeness are likely aware that Doctor D has a very healthy self-esteem. 3 weeks of lying on my back absolutely helpless and unable to do anything had me at the lowest place I’ve every been. One night I—a generally tough dude—cried myself to sleep. I’m up and moving better now, but I will likely have a limp the rest of my life. My whole life I’ve been able to do everything physical I wanted to do. Now I’m one of the broken people. It’s going to take some getting used to.

I know as physician I often see people with broken and damaged bodies. It kind of annoyed me when people whined about it. “Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” It’s easy to feel this way when you aren’t the one with the disability. I’ve given myself that same pep talk a lot in the last two months—It doesn’t work as well when I’m the one with the gimp leg. A lot of my patients have far worse problems than my leg ever was. I’m manning up to fact that my leg’s gonna hurt for decades, but I think I’ll be much more patient towards patients with severe disabilities in the future.

You can’t say you wouldn’t complain about it if you’ve never been there—it’s a good thing for docs to keep in mind.

Oh, where do I begin? While I don’t know the extent of Dr. D’s injury, it must have been pretty severe if he will be limping the rest of his life. However, I would encourage him to not except his current state of health as his health destiny. I believe his body has an amazing ability to heal itself if he just gives it a chance. He has classified himself as “one of the broken people,” but I wish he wouldn’t.

It’s also frustrating to hear him say that he is annoyed when people “whined” about their pain. This goes back to what I was saying earlier about doctors not listening to their patients. It seems as though (prior to his injury) he was assuming that he already knew what was wrong with his patients, so they needn’t bother him with their story. Remember, Dr. D, your patient knows their body better than you ever will, and that’s not a knock on you. You went to school a LONG time and learned a TON of info which is extremely beneficial to your patients, but you can’t negate their expert opinion either. After all, it is their body. I’m glad to hear you’ll be more patient with them in the future. 

Dr D, thank you for your open, honest assessment of your patient experience (you can read his full post HERE). It’s reassuring to hear a physician tell us how horrible his experience as a patient was. My hope is that this experience with make you a better physician as you begin to listen to your patients better. You will (hopefully) prescribe better, and I would encourage you to spend more time with your patients to A) get to really know them and B) find the cause of their symptom. Your patients will thank you for it.

QUESTIONS: Have you had a bad physician-patient experience? What about a good physician-patient experience?