Nurse's Station

When Doctors Become the Patient: The Psychological Implications of a Role Reversal


When Doctors Become the Patient_ The Psychological Implications of a Role Reversal
For physicians, as well as for nurses, one’s occupation puts one in the role of a healer. When it’s your job to treat other people’s injuries and illnesses, it can be jarring when suddenly, you find yourself on the other end of the spectrum. Doctors and nurses may be powerful healers, but they’re only humans, and they’re just as susceptible to illness and injury as anyone else. But for many physicians, assuming the role of a patient can bring its own unique psychological challenges.

The Wounded Physician: When a Doctor Becomes a Patient

Physicians can face surprising obstacles when they themselves require medical treatment. In one groundbreaking 2007 book, When Doctors Become Patients, writer Robert Klitzman examines the challenges that physicians face when they themselves become sick. Klitzman took a qualitative approach, interviewing numerous physicians with conditions like HIV, cancer, and heart disease. The book is composed of chapters that act as a series of vignettes, shedding light on the different facets of the physicians’ experiences. Chapter 3, “The Medical Self: Self-Doctoring and Choosing Doctors,” deals with how physicians approach their own care. Chapter 8, “Being Strong: Workaholism, Burnout, & Coping” deals with the pressures physicians face in the context of their careers. Chapter 11, “Us vs Them: Treating Patients Differently,” examines the distance that physicians often create between themselves and their patients.

One chapter that’s often of particular interest is Chapter 4: “Screw-Ups: External Obstacles Faced in Becoming Patients.” It details how when physicians find themselves in the role of a patient, they often begin to notice problems with the way diseases are approached and treated. They often report that symptoms, especially psychiatric symptoms, are ignored by other medical professionals, and that they feel that their dignity is diminished throughout the experience.

The Paradox of the Doctor as Patient: Approaching One’s Own Health Differently Than Others’

In many cases, after having such an experience, physicians end up with a new perspective on how they interface with their own patients. They may also realize, as Dr. Eric D. Manheimer relates in a 2011 New York Times editorial, that when it comes to their own health and not someone else’s, they can be as irrational as anyone else.

Dr. Manheimer had squamous cell carcinoma of the throat. It began as a small lesion and then spread to his lymph nodes. While he knew intellectually what was in store for him, and knew to trust the physicians who were treating him, he was rather disturbed at what he found. He found that for his physicians, it was all about numbers: his stage of cancer, his loss of weight, the number of steps he could take independently. His world felt small, and although his chances of survival were high at 75%, that other 25% still loomed large in his mind.

At one point, due to his age and his condition, and the adverse effects of the treatments themselves, he made the decision to refuse further radiation and chemotherapy. Although he himself was comfortable in his own decision about his own life, his doctors and family were not. He had found himself in a position that many severely ill patients eventually reach: he was psychologically ready to accept death. He no longer feared it, as so many healthy people do. However, he concedes that this was partly because of a loss of will, which may have rendered him incapable of making the best decision for himself.

Today, he has made a full recovery and is continuing to practice medicine. But his fight with cancer is an experience that has stayed with him. He feels that it has brought him greater empathy for what patients are actually going through, and also, that it drove home the reality of his own mortality and ultimate vulnerability.

The Archetype of the Wounded Healer: How Experience with Illness Informs Medical Practice

Physicians, as well as nurses, have a greater intellectual understanding and base of knowledge regarding human injuries and illnesses. And yet, when we ourselves are the patient, our experiences aren’t always what we’d expect. Fear, anxiety and other emotional responses are present in full force, and when it’s your health and not someone else’s, you’re at just as much risk of acting irrationally as anyone else.

But at the same time, one must consider the archetype of the Wounded Healer. When you yourself have been a patient, and have been through that experience, you can come out of it with a greater understanding of what your own patients are going through, and greater empathy and compassion for their concerns. There can be a light at the end of the darkness of a serious brush with death: you come out with a greater understanding of what that’s really like. And for physicians and nurses, this can improve our ability to treat our patients the way we ourselves would want to be treated.

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