Doctors are said to make the worst patients. But does becoming a patient make someone a better doctor? Columbia University Medical Center psychiatrist Dr. Robert Klitzman explores that question in his latest book, “When Doctors Become Patients.” It’s based on Dr. Klitzman’s own experience as a patient, and on interviews with more than 70 men and women who have experienced both sides of medicine, as doctors and as patients. Some had to cope with depression or cancer; others with heart disease, H.I.V., hepatitis or various other illnesses. When doctors get sick, they discover fissures in the health system that they didn’t know existed. They learn that seemingly small annoyances they never paid attention to as doctors — like long waiting times or a broken television in a hospital room — really are a big deal when you are the patient. Even doctors who thought of themselves as compassionate recognize they can do better once they experience life as a patient. Dr. Klitzman starts the book with his own poignant tale of illness. His sister worked on the 105th floor of the World Trade Center and died on Sept. 11, 2001. After the funeral, his body gave out. He couldn’t get out of bed. He developed what felt like the flu. Even though he’s a psychiatrist, he resisted the notion that he was depressed. Later, after acknowledging his illness, he gained new insight into his own patients. He was amazed at how pronounced the physical symptoms of depression really were. “I felt weak and ashamed, and began to appreciate, too, the embarrassment and stigma my patients felt,” he writes. I spoke with Dr. Klitzman this week about what he and other doctors learned after becoming patients themselves. In the book, you share your personal story of illness. How difficult was it for you, as a doctor, to admit that you had also become a patient? I felt like I was “coming out” with it. I think there is a stigma with being a psychiatrist or any kind of doctor and talking about being depressed or having any illness really. I feel like I’m putting myself out there. I realize people may be looking at me differently. I cringe a little bit, but I feel the purpose and the point is important. Many doctors then come up to me or e-mail me about their experience with illness. My talking about it has freed up people to speak about this. But doctors know more than anyone that people get sick. Why is there a stigma when a doctor gets sick? I have a chapter called “Magic White Coats.” Doctors felt again and again that they wear magic white coats. Illness happens to them over there, not to us. It starts Day 1 when you go to medical school. The first day you are given a cadaver and told to start opening it up. It immediately distances you. Over there is sickness, illness, patients, disease and death. And you are here. It’s part of the hubris of medicine. It teaches a professional hierarchy over patients and over disease. Some of the doctors in the book said they worked harder when they were ill. One doctor said, ”If I worked harder and harder and treated more patients and helped more people, then I wouldn’t get sick, and I wouldn’t die.” How does learning about a doctor’s experience as a patient help the rest of us? It can help train doctors to do better. When patients complain, we think, “That’s just a patient complaining again.” We dismiss it way too often. These doctors, because they have this unique position as patient and doctor, they can say, “I’m one of you guys and these are the things we’re doing wrong.” So what did they learn? One thing they became aware of is how patients try to please their doctors. The doctor stands in the room and says, “Is everything O.K.?” Everything is not O.K., but they realized that if they say that, the doctor gets a long face. There is a normal natural instinct to want to please people. They realized that this must mean their patients have all these years been trying to please them. It gets in the way of doctors and patients really saying what is wrong. They think doctors unconsciously don’t really want to hear about problems. Patients often feel uncomfortable saying a lot about what’s going on. In your book, you talk about how many doctors, including yourself, were surprised at how powerful some symptoms of illness really are? I interviewed a gastroenterologist who treated abdominal pain and suddenly she developed it. She said, “I had no idea that when patients said pain, this is what they were talking about. It was so much beyond words.” And she couldn’t describe it. Patients have to learn to really convey as powerfully as they can when things are painful. Take nausea and fatigue. Doctors said that for years they had sort of dismissed those kinds of symptoms. But then they had nausea or insomnia, and they said, “It was so much worse than I ever would have imagined.” That, to me, means that we as doctors are missing the experiences patients are suffering. We don’t pay attention. What was the most surprising thing you learned from doctors who became patients? The spiritual issues. Doctors would spontaneously say they realized how important spiritual things are. They’d say, “Patients used to ask me to pray for them, and I’d say, ‘Whatever.’ When I became a patient, I realized how important that was.” Medical school doesn’t teach a single thing on religion or spirituality. The doctors weren’t getting it, but they realized that was important, particularly when facing end of life. Some of these doctors even said, “I don’t believe in anything, but I reconsidered my beliefs.” Or they tried to find something they believed in. They said, “I realize it helps my patients.” I didn’t expect to hear any of that, but again and again it came up. What did spending time in the hospital teach doctors about life as a patient? They talked about the physical plant and the bureaucracy — things like a broken window, all that stuff we put aside in training. That’s not important, but of course it’s important. Again and again doctors talked about how the TV in the room didn’t work, or the phone didn’t work. They also became aware of how many mistakes are made, like the wrong dose of medication. They were astonished by that. How does the experience of having an illness change how doctors treat patients going forward? These were good doctors to start. I always thought I was compassionate and listened. I had no idea what patients were going through. My eyes were completely opened. One surgeon told me that the night before he underwent surgery, his surgeon told him there is a 5 percent chance you will die in the O.R. He could have said, “There’s a 95 percent chance things will go O.K.” He had been a surgeon for 30 years, and he said he’d never thought about how those two kinds of information trigger such completely different emotional responses. Rather than standing at the foot of the bed, another doctor would sit on the edge of the bed and fill out the chart, giving him a few more moments of interaction. The fact that he would sit down made an impression. After having that experience, the doctor said, “Since then I’ve done that with all my patients in the hospital.” … Another doctor always says to patients now, “I’m sorry to have kept you waiting.” He never said that before. Source
