By Winnie Natu, MSIV
While on clinical rotations, I had the good fortune of meeting a
wonderful doctor, teacher, and woman. During our time together she shared a
personal story that has truly affected me and the way I view the doctor-patient
relationship. As a physician, Dr. X was well aware that her mother dying
at the age of 45 of breast cancer meant more than dealing with the grief that
accompanies losing a parent at a young age; it meant she herself may have an
increased risk of the disease. She was tested for the BRCA gene mutations that
are associated with a greatly increased risk of developing breast cancer. Her
test came back positive for one of the genes and without hesitation she had a
preventative double mastectomy.
She recalls only half hearing what her
own physicians told her about the risks of the procedure and that there was in
fact a chance that she might not develop cancer and that if she did, other
treatment options may be available at that time. Of course she was
thinking about her children and husband as a motivating factor for getting the
surgery but often, she thought of her mother and what her life became in the
last years of her life. Dr. X could not let go of the feeling of not wanting to
be the patient. After years of being in control of her education and training
and later her patients’ health, she could not give up the autonomy and
authority that came with that. After years of fighting other people’s
illnesses, she could not face that an illness would dictate her own life and so
she saw no option but to take control as she had all her life with the mastectomy. 
We as doctors want our patients to leave their WebMD facts and
preconceived notions at the door and follow our advice. Can we do the
same? An article on the ACP internist recently posted results of a study that
posed clinical scenarios to randomized groups of physicians. Both outcomes
involved a choice between surviving a fatal illness but with sometimes
crippling outcomes. Physicians were randomized to groups in which they imagined
themselves as the patient facing the decision, or in which they were
recommending an option to a patient. “The hypothetical scenario involved two
types of surgery for colon cancer. The first type of surgery cures colon cancer
without any complications in 80% of patients, results in death within two years
in 16%, and 1% a piece would experience a colostomy, chronic diarrhea,
intermittent bowel obstruction or a wound infection. The second type of surgery
cures 80% without complications, or results in 20% mortality within two years.
Among 242 respondents, 37.8% chose the treatment with a higher death rate for
themselves but only 24.5% recommended this treatment to a hypothetical
patient”.
These and results of other studies like this tend to highlight the
same concept for me: it is imperative to get to know your patient. Doctor,
lawyer, teacher, home-maker: each comes with their own set of personality
traits, priorities, social/financial circumstance, and personal experiences.
Knowing these characteristics as a physician allows for providing
individualized medical care that will tend to have the strongest compliance and
best long-term outcomes for the patient. Our job after all, is not to
always carry out what we think is right but often what is right for each patient.
Moreover, what Dr. X described: the unwillingness to give up control, the
thought that “I know what is best for me”, fear of vulnerability etc. is not
restricted to physician patients! It is important to remind ourselves that our
patients, regardless of profession, have at least some of these feelings every
time they come to us and that it is a great privilege that we are entrusted
with their care.
Link to ACP internist: http://getbetterhealth.com/evidence-that-doctors-make-bad-patients/2011.04.18
