Monday, December 30, 2013

Personal Reflection: When The Doctor Becomes the Patient

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.

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