I have an admission to make. I have not seen a primary care physician in 5 years. As a resident the excuses come easy. Getting the smallest of chores can become a mammoth task in the face of an 80 hour work week. However, the fact remains, the things I really want done, get done, seeing a doctor does not. I even have really good reasons to see a doctor. I have tests that really should be done once every few years. I have had real problems that I have shoved aside, little things here and there that probably should really be checked, but deep down I don’t want to do it. Why is this?
Medical Education and the road to becoming a physician is an interesting transition. As medical students we know just enough to be dangerous. We are still learning the language, we go to the doctor’s office and they assume we know much more than we really do. The one thing we do know is how to research and find what the absolute most frightening, wretched awful condition there is in existence that could possibly explain our symptoms. The stress and anxiety we experience trying to ingest vast quantities of information can go to our heads. It is common for Med students to develop symptoms of every disease they learn about. I was a complete and total hypochondriac in medical school.
As we get further along, we learn better and we overcompensate. We no longer can admit when we are sick. Add in the mix, the extreme workload, the tough worker culture, and the stress it causes your peers to get sick and you become the expert of denial. I have actually heard ER attendings state that you aren’t there as a resident you better be there as a patient. The stories about dehydrated residents with solid puking for 24 hours giving themselves IVs and a slug of anti-nausea medicine are true. I have seen it live and in person.
The system makes us illness deniers. There is no sick role allowed for the healer. We have this complex. Sickness is weakness. It’s actually quite unhealthy now that I think about it. At its bottom, this translates to a subtle contempt for our patients. Its just one more example of how our medical education system and culture is sick and dysfunctional.
Another part of the problem is having already having the choice experience of taking care of health professionals ourselves. It is a truly painful experience. Everyone walks on eggshells around them. You see, we physicians know the every hole, every crack, every possible pitfall in the system. We are all too aware of the mistakes that get made here and there. My wife has gotten to the point that she is deathly afraid of hospitals just from stories I have told her. Shes been disillusioned by proximity. Of course, the negative stories are much more sensational and make for better conversation.
We physicians are also obsessive compulsive. We have to be to survive on the job. So when we get sick and self preservation kicks in, we jump into hypercritical mode. As I have observed staff taking care of a physician, they live in constant fear of being jumped on for any small error, or apparent mistake that may come along. Ironically, we fear our health care system more than anyone. Familiarity breeds contempt.
Fear will quickly turns mankind into an irrational, stupid, snarling, ugly animal. While we deal with this fact in (some)patients everyday, we are doubly guilty when we are the on the receiving end of care. I mean how do you talk down the anxiety of someone who is seems higher in the social hierarchy? I pity the poor nurses.
When we are sick, we become the only patient we need to worry about. We can focus all our nervous energy into researching our condition. This is a bad, bad thing. The further I go in training the more I realize their are many different ways to approach a clinical problem in medicine. Each has its own advantages and disadvantages. Both can be right. This life lesson goes out the window when we become a patient. There is only one way to do this and its our way. After all we are the doctor, or a doctor, or something.
I know these things shouldn’t matter. In fact, I avoid the doctors office just because the exaggerated deference is frankly embarrassing. I hate hierarchy. I don’t want to be chief, but that is just me. It actually gets in the way of just trying to relate and build a relationship with caregivers. You can’t ask questions for clarification. We get triple doses of clinical explanation without any of the reassurance, comfort, exploring of fears, dealing with grief, and mourning of loss that are truly the art of medicine. We just don’t know how to act when the physician-patient relationship suddenly becomes a level playing field. It is an inherently uneven field even in the most patient empowered and progressive of practices. Illness makes us vulnerable. Doctors don’t deal with mortality very well. We spend too much of our lives fighting it.
The rumor mill is also out of control when a doctor is in the hospital. We don’t want to get sick because every piece of our condition will soon be front Everyone gets curious. HIPPA violations spread like wildfire. Congress will always lose versus the social structure of the hospital.
So the next time you are in the hospital, realize it could always be worse, you could be a doctor. Transversely, If you seem to be driving your physician nuts, now you can kindly remind them that they could always be taking care of a fellow physician. 😉