Lisa Freitag says:
Dr. Lisa Freitag is a former pediatrician in Minneapolis, Minnesota. She wrote some guest posts for us in 2013, and we are delighted to have more of her insightful presence here. This is the first half of the third (and last) part; Part 2 and a link to Part 1 are here. We’ll finish Part 3 in the next couple of weeks, between posts from Laurie and Debbie.
People have said, “Doctors make terrible patients,” to me, usually with a little indulgent laugh, as a sort of joke meant to partly excuse a demonstration of un-patiently behavior on my part. Maybe doctors as a group are bad at receiving care; I certainly am. I am a terrible patient.
I curse, I scowl, I second-guess science, and I resolutely refuse to be cheerful in the face of adversity. I resent the whole package of being ill; the discomfort, the weakness, the interruption of better plans, and especially the reduction in status from person to patient. Waiting in a room full of other supplicants for access to the purveyor of all that is holy, creates in me a gnawing and impotent anger. The knowledge that, at a different time, I held this power over others, and believed it to be benign does not improve this anger. While I was working as a doctor, I felt rather put upon, because there was only one of me, and all those people were out there in my waiting room, waiting for beneficence.
Although I suspect that I am not the only doctor who harbors a creeping uncertainty about the truths of the religion that is medicine, very few have ever admitted it to me. I have witnessed very few of my fellows during illness, so I cannot vouch for their terribleness as patients. I cannot assume that my reasons for being a doctor who is a bad patient are typical, nor can I support the hypothesis that doctors universally suck at patienthood. But some of the things I was taught over the years, do seem to indicate that doctors would, in fact, be unlikely to adapt well to the role.
One of the first things we learned in medical school is that doctors do not get sick. Of course, doctors get the flu, or feel crappy, but there are no offers of sympathy, no postponements of work to be done, no allowance for time off. Any display of weakness, or need for allowances is considered inappropriate. Your personal life must not interfere with the important work of medicine.
When I was in my third year of medical school, one of the interns, two or three years ahead of me in training, got stomach flu while on call. After a few hours of vomiting and diarrhea, he thought he might be getting dehydrated. So he started an IV on himself and continued working. Somewhat later, a mother, not recognizing him as a doctor with his scrubs and IV pole, complained that a “patient” was examining her child. The intern was reprimanded for his error, but he was not sent home to recover in peace. He merely heparin-locked the IV while seeing patients, so that it would not be visible.
This was not an isolated incident. Doctors never call in sick. If you get two hours of sleep the night before, or have a low-grade fever, or feel like you might be coming down with something, you go to work. One of my partners worked until noon the day he had surgery on his back, because his procedure wasn’t scheduled until 1:30 PM. The same guy never forgave me for my son’s premature birth, not because I had stupidly failed to recognize signs of early labor and continued working, but because my sudden absence really messed up the schedule.
Thus doctors spend all day examining the bodies of sick people, while not tolerating any sickness in themselves or their peers. The combination of ignoring one’s own body while spending every waking hour attending to the needs of others’ broken bodies, cannot be healthy. This dissonance between realities breeds, I think, a general disrespect for the body and its functions, and a specific suspicion of the person who is ill. Being sick becomes an inability to control the body, a sort of failure of character.
The main thing one learns in medical school is medicine. Tons upon tons of science, all directed at the battle against disease. To keep being a doctor, one must be convinced of having a chance of actually winning. So we forget what that we know all bodies must eventually break down, and concentrate on bolstering the body’s defenses. Many patients these days are offered only optimism, encouraged to hope for a cure, even if one is unlikely. At the same time, doctors often know from experience what the worst looks like. In a serious illness, a doctor must walk a tightrope between hope and despair, remembering past triumphs and failures in similar situations. Suppression of this knowledge can become a necessary component of maintaining the proper optimism.
The refusal to display or acknowledge illness reinforces the popular image that being a doctor confers an immunity to the things that plague the rest of the world. There is some implication that doctors deserve this reward. Doctors themselves seem to accept, if not expect, the benefits of their superiority, from waived parking tickets to large incomes. Apparent immunity to illness is another perk, explained away scientifically by the assumption that doctors supposedly enjoy the very best insurance and preventive medical care. Thus, we can bury quite deeply both the knowledge that we might become seriously ill and the fact that death is inevitable. When another doctor needs medical care, everyone involved is reminded that it is a fiction, and the illusion fails. Neither doctor nor doctor-turned-patient appreciate the reminder.