When doctors become patients
What happens to doctors who travel to the kingdom of the sick? Do they notice small things they have overlooked when treating patients? How do they behave as patients? And does an illness make an impact on their perception of disease?
Sanjay Nagral
Oct 2, 2020, Mumbai Mirror
Last week, I was talking to a colleague who had just recovered from prolonged hospitalisation for Covid. After we had exchanged the usual niceties, I asked how the hospital experience was. He said, “The staff looked after me very well. But I didn’t sleep a wink for a week. I couldn’t eat anything. Wonder how our patients manage. I would now really think twice before I advise hospitalisation to anyone unless I hate that person.” And we laughed politely.
Most of us will be patients at some stage in our lives. That includes doctors. Susan Sontag, the prolific American author, in her book ‘Illness as Metaphor’, writes: “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”
What happens to doctors who travel to the kingdom of the sick? Do they notice small things they have overlooked when treating patients? How do they behave as patients? And does an illness make an impact on their perception of disease? These questions are very old but with a large number of health workers infected by Covid, they have acquired a certain urgency.
Over the years, many doctors have recounted their experiences as patients in moving prose. Rana Awdish, an American physician, had a sudden rupture of a liver tumor when she was pregnant. She had massive bleeding. Her liver and kidneys shut down, her baby died. She needed five major surgeries. She has related her experience in a book called ‘In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope’ .
She writes, “Physicians tend to speak to each other rather than thinking about the impact their words will have on their patients. The patient is at risk of becoming an object.” She describes miscommunication, uncoordinated care, and even obvious insensitivity. “When I finished my training, I was entirely oriented to disease. Patients were the thing disease happened inside of.” She confesses that she came out of her illness a very different doctor.
Columbia psychiatrist Robert Klitzman based on his own experience as a patient and interviews with doctors who have been patients has written a book titled ‘When Doctors Become Patients’. The protagonists talk about how when they got sick, they discovered fissures in the health system that they didn’t know existed. They learn that seemingly small annoyances they never paid attention to like long waiting times are a big deal when you are a patient. Even doctors who thought of themselves as compassionate admitted they can do better once they experienced life as a patient.
Few years ago, Sunil Pandya, a senior neurosurgeon penned a candid account of his experience after prolonged hospitalisation for spine surgery. His story, published in medical journals, illustrates the ‘trivial’ things noticed with the lived experience. Sample this: “Like many before me, I bemoan the design and construction of the bedpan, which is especially painful to a person who has recently undergone spinal surgery. Bedpans are usually constructed of stainless steel and are cold, hard and uncomfortable”. Or: “My complaints of loss of appetite usually inspired comments such as: Consider food as medicine and take it slowly; take small quantities every hour or so. I had already tried these measures but the feeling of a huge load in the stomach rendered these ineffective. Often several complaints are brushed aside with a statement such as ‘Don’t worry about this. It will soon disappear’.”
Counterintuitively, doctors are not ‘ideal’ patients. They ignore symptoms of disease and delay treatment. They are well known to hide mental health problems and have one of the highest rates of undiagnosed depression. They can also ignore advice they give to their patients when it comes to them. Addictions is a common cause of illhealth amongst them. Let me confess that I have often not been able to complete an antibiotic course! It is indeed easier to pontificate to patients on regularity, discipline and selfcare.
Covid is pushing doctors to the illness kingdom in large numbers. Some have even succumbed to it. Doctors are usually treated preferentially in the healthcare system. But in Covid, some have experienced first-hand the difficulties ordinary people face in negotiating healthcare. Delays in ambulances, unavailability of beds, filthy toilets, absence of senior doctors, rude behaviour, astronomical costs are being discussed on doctors’ WhatsApp groups. Will this felt experience spur them and their associations to address these issues collectively? Will it make them perceive the incidents of violence by unruly family members of patients a bit differently?
Of course, like patients, the Indian doctor is also not a monolith. Even as a patient, the experience and expectations of, let us say, a non-MBBS rural practitioner is likely to be very different from a privileged urban specialist. In Mumbai, doctors who died of Covid waiting for an ICU bed have been those low down in the medical hierarchy. If Sontag were writing in the Indian context, she would have to mention three if not more kingdoms; the well, the ill and the vulnerable and ill.