When the Patient Is a Doctor : * Health: They are ill-prepared to deal with sickness and loss of control. Often, they find, other physicians are less professional with them.
Dr. Art Ulene was feeling fine, hadn’t been sick in 31 years when he checked into a Los Angeles hospital because of a dramatic drop in his blood sugar. But after 24 hours confined to bed, he was “profoundly weak and deeply depressed” by the institutional routine. Besides being bed-bound, he wore hospital gowns and rode wheelchairs to his various tests--which made him feel sick although he wasn’t.
Ulene, who got a clean bill of health, was so unnerved by his hospital stay that he rushed to see “The Doctor,” a film about a physician who gets sick.
“I broke into tears in the theater that night,” recalls the KABC-TV health guru. The movie intensified his feeling that, except for his hospital stint, he’d never known what being a patient really meant. Ulene is not alone.
Doctors often don’t understand the problems of patients, many doctors admit. That’s partly because until doctors get sick, they have no idea what it’s like to give control of their lives to someone else. And in the confusion of finding out, they sometimes wind up with worse medical care than other patients would get.
“As physicians, we touch illness constantly, but it never touches us,” says Dr. Cary Kaufman, a surgeon at Long Beach Memorial Hospital.
“When we get sick, suddenly all our learning flies out the door. We go through the same denial process as everyone else, except we come up with sophisticated medical rationales to convince ourselves we’re really all right.”
Kaufman says many doctors don’t get regular check-ups, as they tell their own patients to do. They either discover their own illness very early--or almost too late.
“Doctors are terrible patients,” agrees Dr. Steven Gundry, a thoracic surgeon and associate professor Loma Linda University Medical Center. “They delay seeking treatment, and when they finally do, there’s a lot of coddling that goes on.
“The doctor usually goes to a physician friend for help. The friend makes an educated guess--but sometimes doesn’t do the appropriate tests. If a stranger walked in, you’d give him the works. But if it’s a friend, you try to spare him or her--and sometimes you miss something big.” Gundry says a wrist ailment was once misdiagnosed, and as a result he lost a year in his surgical career.
Doctors who seek treatment elsewhere get a different kind of shock, Kaufman adds. They are used to being treated with deference, which they don’t receive in a strange hospital. “Nobody puts a name tag with a big MD on their hospital gowns, so they’re treated like anyone else.”
In other words, they’ve lost control. And most doctors, Kaufman adds with a laugh, are “real freaks about control. When they lose that, they think they’ve lost it all.”
Dr. Edward Rosenbaum, an internist in Portland, Ore., almost lost it all in 1985, when unrelenting hoarseness struck.
Until then, Rosenbaum was a happy, well-respected man with a wife and three physician sons. He was a founder of the University of Oregon’s rheumatology clinic and author of medical texts.
When his hoarseness didn’t go away, he asked a physician friend to take a look. “Nothing wrong,” he was told.
When the problem persisted, he “grabbed another doctor in the hall” and asked for an exam. Again, the report was clean.
When his voice got so bad that patients couldn’t hear him, Rosenbaum asked a friend to do a biopsy, which also showed nothing. “It’s psychological,” he was told.
At a speech-therapy clinic, the chief doctor said, “You’re using your vocal chords incorrectly” and took a film to prove it. The results shocked them both. It showed a malignant tumor.
Rosenbaum had trusted his doctors, who were also his friends, who had told him nothing was wrong. Yet, Rosenbaum wasn’t vindictive or angry, he says, because “every sin I’ve accused my doctors of, I’ve probably committed myself.”
His voice is now back to normal, after surgery and radiation therapy. “I look at it this way,” he says: “My grandfather would have died from this, my father would have lost his voice. I lived and I kept my voice.”
Rosenbaum retired and wrote a book, from which the movie, “The Doctor,” was adapted. But some critics--among them doctors--say parts of the plot seem too far-fetched. Rosenbaum maintains that it is accurate.
For example, the character who dies of brain cancer because she wasn’t given a very basic diagnostic test represents someone he met while undergoing chemotherapy. “It happened in real life just the way it happens in the film,” Rosenbaum says. “Only in real life she wasn’t a single woman. She was a doctor’s wife.”
Dr. Nisar Syed, director of radiation oncology at Memorial Medical Center in Long Beach, says patients who are doctors “probably expect better treatment than other patients do. They sometimes want to be seen right away, without having to wait.”
Or they feel their doctors are not giving them enough time. But some physicians don’t have that much time to give--even to colleagues, Syed says.
Other doctors are just not good communicators. “Some of the best surgeons, the ones who get really great results,” are not very good at talking to patients--even to patients who are doctors, he says.
“Doctors who become patients are quick to second-guess, quick to think the worst, and they have difficulty being objective about their own conditions,” says Dr. Neil Wenger, co-chairman of the UCLA hospital ethics committee.
“I didn’t see my surgeon very often after the surgery,” says a Los Angeles orthopedic surgeon operated on for colon cancer. “I thought he would have stopped in to see how I was doing, as I always do with my patients,”
The problem was exacerbated when a radiologist performed an extremely painful experimental procedure--without telling him it was experimental. “They treated me like an . . . animal,” says the doctor, who asked that his name not be used.
Even more astonishing to the now-recovered doctor was the fact that his calls to other doctors went unanswered. “I requested a particular radiologist but was never able to get in touch with him. He never returned my messages,” nor did anyone in his office. “He wasn’t there for me--he just didn’t care.”
A Los Angeles ear, nose and throat surgeon has an equally gloomy report. After a stroke, which temporarily erased his ability to speak, he was hospitalized by an internist who “up and left for New York because his wife needed a vacation.”
That wouldn’t have been so bad, but the departed doctor didn’t leave anyone to sign the patient out of the hospital. Since he had no voice, he couldn’t use his considerable clout to arrange his own release, the doctor says.
Now back in practice, with about 90% of his speech restored, the doctor says his surgical and diagnostic skills are “better than they ever were.” But one thing will never be the same, he says: His perception of what it’s like to be a patient. “It’s awful,” he says, “sheer hell.”
Dr. Stephen Brunton, director of the family practice residency program at Long Beach Memorial Hospital, has designed a program to “give residents empathy, so they can better understand their patients’ plight.”
Most young doctors have never been hospitalized, Brunton says, and can’t imagine that the routine--the IVs, the middle-of-the-night blood pressure tests, even the stress of signing in--can produce physical or emotional pain. It all looks so easy, he says, but even the most aggressive residents who become patients find that they are forced into an amazing dependency.
The idea for the program--one of many used throughout the United States--started while Brunton was a medical student and wore his eyeglasses during a a karate match. A competitor kicked his glasses, which shattered into his eyes. After surgery, he’d wait each day for the doctor to come to his room and examine his eyes.
“I was waiting to learn whether my vision could be saved--but I had so much anxiety about it that I couldn’t process anything the doctor said. I heard his words, but I’d have to wait until he left, then ask the other patient, ‘What did he say?’ ”
