On the other side of the consultation: when the doctor becomes a patient | Science

On the other side of the consultation: when the doctor becomes a patient | Science



We are all potential patients. At various times in our lives, diseases appear and remind us of the value and fragility of health and life. Regardless of our ethnicity, education, economic status or work, we will face both minor and transient diseases as well as serious and / or incurable diseases. The loss of health ends up happening to everyone, including those whose profession consists of dealing with it every day: doctors.

Accustomed to seeing and treating the disease in others and not in themselves, when the tables are changed and pass to the other side of the consultation, these peculiar patients often face the disease in a different way. Paradoxically, during their demanding medical careers, they have been taught to recognize and treat innumerable diseases, but never to be sick. This phenomenon of the doctor as a patient has not gone exactly unnoticed, which has been collected in books, newspaper and television reports and even in multiple scientific studies.

Some doctors compare the fact of recognizing their illness with the fear of "coming out of the closet"

The psychiatrist Robert Klitzman, affected by depression after the death of his sister in the Twin Towers on September 11, broke the silence as a sick doctor in a book entitled "When doctors become patients". In turn, he interviewed 70 doctors and doctors who had been on both sides of the consultation. Putting yourself in patients' shoes reinforced the empathy that doctors felt for their own patients. In addition, their experiences helped them to realize many health system failures and details of the disease that they ignored or did not properly assess before becoming patients. Thus, like the rest of the mortals, they faced the waiting lists, the errors in the medication or the delicate interaction with their doctors to discuss the good news or bad news.

Emotions and percentages

For example, a surgeon was aware, for the first time after 30 years of professional practice, of the great difference in the emotional impact of saying before a surgery: "There is a 5% chance of death" or "There is a 95 % chance of doing well. "Another doctor, after his experience as a patient, always looked after his own since then with" I'm sorry I made him wait. "Patients' pain perception also changed for doctors affected by a disease where this symptom was also present, although they had heard many times before their patients' explanations about the pain they suffered, it was not until they suffered it themselves that they could really understand what they were going through.

Despite these positive stories, the truth is that diverse studies They reflect that doctors are reluctant to see themselves as patients and to ask for help. Yes, in other words, doctors tend to be bad patients. The subtle atmosphere of invulnerability floats in the sanitary environment, as if it were not possible for them to get sick themselves. In fact, it is a stigma for some of them who come to compare the fear of recognizing their illness with the fear of "coming out of the closet".

The above is especially true when suffering from mental disorders such as depression, anxiety and addiction. Paradoxically, these health problems are much more frequent among doctors than among the general population. In fact, between 10-20% of doctors suffer from depression at some point in their careers and their risk of suicide is considerably higher than the general population (250% higher in doctors and 70% higher in doctors). However, recognizing that you suffer from any of these disorders is seen as a sign of weakness that many are not willing to take until it is too late. Partly because recognizing these health problems can face consequences such as the prohibition of the exercise of medicine or the withdrawal of medical leave, depending on the country. On the other hand, some doctors feel uncomfortable to have colleagues as patients and know intimate medical details of these can hinder the professional relationship between them.

False sense of control

Often, doctors often convince themselves that they have their symptoms under control or underestimate them, until they can not hide it anymore. Especially dramatic was the case of the London psychiatrist Daksha Emson. He suffered from a bipolar disorder that he hid from his colleagues out of fear of stigma. She was in the middle of a brilliant career and she was terrified of the consequences they would have for her if her illness were discovered. Because of that, all he did was make quick consultations to certain colleagues in the corridors of the hospital.

Doctors reject treatments and operations in terminal illness more often

When Daksha left his medication after the birth of his daughter, his violent delusions and his obsession with evil spirits were unleashed. In the year 2000, she killed her daughter after multiple stabs "to protect her from the devil" and, later, set herself and her daughter on fire. Daksha died three weeks later in the burn unit. The British health system (NHS) was accused of complicity by negligence in this case. Among the recommendations to prevent more health workers from finding themselves in this situation, a code of conduct was proposed to combat the stigma of mental disorders among NHS staff.

Another major difference between physicians and the general population is how they face the first at the end of life or how they are planned before the disease. On the one hand, they are more inclined to make the declaration of anticipated wills (Living will), document by which therapeutic strategies or organ donation are decided in case of not being able to communicate their will. On the other hand, as explained in the famous article by Dr. Murray "How doctors die", doctors know much better the futility of medical treatments in terminal diseases and, as a result, reject these treatments more often.

For example in a study published in the JAMA magazine, it was observed that doctors were less likely to die in the hospital, compared to the general population, and during the last six months of life they were less likely to undergo surgery or be admitted to the ICU. Ironies of life, when the end of life is approaching, doctors are one of the groups of people who most want to leave voluntarily from medicine.

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