What this doctor learned when he was a patient

Doctor D has been blogging about the  doctor-patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.

Doctor D recently found himself on the patient side of a nasty injury.

Even as Doctor D looked down and realized his leg wasn’t supposed to be that shape he said to himself, “Self, take mental notes! The readers of Doctor D’s Clinic of Doctor-Patient Relational Awesomeness will want to know about this.”

Here is what Doctor D discovered when he became Patient D:

1. Doctor D Is mostly right. Any reader of this knows that Dr. D’s insight is typically brilliant and totally useful. I found myself actually looking up posts I had written for the solid and useful advice.

But even D has a lot to learn, so from here on I shall delve into the dark secrets I could only discover when crossing the line to the patient side.

2. Being the patient Is the hardest job In medicine. We doctors think we have difficult work. We have to slave our asses off for years in school. We are expected to be perfect and heroic while working with huge uncertainty. We try to protect your health, comfort, and life, while you patients just lay back and get taken care of.

Lying here isn’t as relaxing as overworked docs think it is.

Just a few days as a hospital patient cleared my mind of any misconceptions. Abject helplessness combined with severe pain trumps everything. And helplessness is far worse than pain. Dr. D had never done anything as a doctor that caused more stress than allowing myself to be put to sleep for a major operation with a surgeon I had only spoken to for 30 seconds.

3. There is much more to pain than a number. Doctor D has written a lot on pain scoring, so I attempted to rate my own pain as a matter of curiosity. I have a good imagination for what 10 out of 10 pain would feel like, so I gave the feeling of multiple shattered bones crunching whenever my leg moved a 7, which made it the most intense pain I’ve ever felt, but I could totally handle the excruciating acute pain.

The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won’t leave can make a person much more miserable than 10 out of 10.

4. Narcotics suck. I’ve seen a lot of nice people get addicted to opiate pain medicines. So Doctor D was the dude in the ER with a bone sticking out of his leg begging not to be given morphine. When they finally convinced me to take the narcotics I was please to discover I didn’t get any high. But what I did discover is that they made me miserable in other ways. I was groggy, nauseated, itchy, constipated, and mushy-brained whenever I had to use them.

Their efficacy varies drastically from person to person. I can say with certainty that a 400 mg Ibuprofen was significantly better for pain for me than a 10 mg Percocet, but since my Ortho wouldn’t let me use ibuprofen I was stuck with narcotics. So I then had to deal with the suspicious look when I told the doc I needed more because I had run out.

I am so happy to be off those things. As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.

5. Being disabled can really crush an ego. Regular visitors to The Clinic of Doctor-Patient Relational Awesomeness are likely aware that Doctor D has a very healthy self-esteem. 3 weeks of lying on my back absolutely helpless and unable to do anything had me at the lowest place I’ve every been. One night I—a generally tough dude—cried myself to sleep. I’m up and moving better now, but I will likely have a limp the rest of my life. My whole life I’ve been able to do everything physical I wanted to do. Now I’m one of the broken people. It’s going to take some getting used to.

I know as physician I often see people with broken and damaged bodies. It kind of annoyed me when people whined about it. “Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” It’s easy to feel this way when you aren’t the one with the disability. I’ve given myself that same pep talk a lot in the last two months—It doesn’t work as well when I’m the one with the gimp leg. A lot of my patients have far worse problems than my leg ever was. I’m manning up to fact that my leg’s gonna hurt for decades, but I think I’ll be much more patient towards patients with severe disabilities in the future.

You can’t say you wouldn’t complain about it if you’ve never been there—it’s a good thing for docs to keep in mind.

6. There isn’t a “sort of person” these things happen to. Okay, I have to admit something a bit embarrassing here: We doctors sometimes think of our patients as a completely alien form of human life. It isn’t intentional. We wouldn’t even admit it out loud. It’s a weird psychological quirk that happens like a reflex.

Doctor’s see so much suffering and misery on a daily basis, and we just can’t spend all our time worrying if it will happen to us too. So we develop this mental trick: “These things won’t happen to me, because I’m not that sort of person.” What sort of person? Well, the sort of person who ends up the patient with a painful or horrible condition, of course!

Unfortunately, psychological defense mechanisms are useless when the cold, harsh laws of physics apply pressure to human bones. This shit happens to everybody—even doctors. No one is the sort of person that has a debilitating injury, until it happens.

7. Some doctors just can’t be helped. Doctor D has spent a lot of time educating you on how to deal with difficult doctors. One of the worse maladies plaguing the medical field is piss-poor communication, and Dr. D’s orthopedist has about the communication skills of a mentally-retarded clam.

There’s a lot that patients can do to improve their communication with difficult doctors. I had a lot of questions, and I found myself going and reading my own posts for advice on how to get answers out of a doc with weak bedside manner.

In the end I just gave up. This dude just couldn’t communicate like a normal human being with a patient (even a patient who had an MD). I hear he’s an excellent surgeon and the fact that my leg got put back together is proof of this, but his ability to converse was just dismal.

“I’m sorry, but I don’t consider speaking with you to be part of my job description.”

When faced with a doctor who simply will not or cannot communicate a patient has two options: Leave or trust blindly.

Dr. D had a FUBAR leg, there was only one orthopedist available at 1am, and the ER doc said this dude was a good surgeon. So I trusted him even though he seemed mentally incapable of explaining the operation he was going to do. The gamble paid off and the leg is improving, but generally I would have to advise that you hit the road when paired with doctors incapable of communicating—especially if your doctor will need to manage your problem longer than a 2 hour surgery.

“Doctor D” is a physician who blogs at Ask An MD.

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  • Anonymous

    Of course, your patient experience didn’t include wondering how you are going to pay for your care.

    • Doctor D

      Actually it did include worrying about finances.  Fortunately I’m not unemployed and uninsured, but I am an independent contractor who has to buy my own high-deductible insurance.  So I didn’t get paid a penny during the nearly a month I was on my back and I had to pay $4,000 out of pocket. 

      As a young MD who is still paying on medical school this definitely caused me to loose some sleep. 

      • Anonymous

        I thought that high deductible health plans were the best thing since sliced bread.  If someone with a six figure income is worried…

  • Anonymous

    During every inpatient stay I’ve ever had I remember thinking that all doctors [and nurses] should be required to be an inpatient for a week, with no special privileges, before they can practice independently.  Even without the pain or illness they could still get a general idea of what it’s like.  Unless they’ve been a patient themselves, doctors and nurses just don’t understand and it’s evident when you talk to them whether they’ve ever been on the other side.  

  • Mary St George

    Orthopaedics seems to draw on a very different set of talents from communication. It seems to me that the worst communicators among orthopaedic surgeons do the nicest handiwork. They should be paired with another orthopod who can both speak and listen, but who has less admirable fine motor skills, for optimal impact on the patient’s mind and body. Orthopod 2 should have his her/own grandmother there, saying “you can look, but DON’T TOUCH!” 

    Unfortunately the impact on cost-effectiveness would be dismal.

  • http://www.facebook.com/people/Betsy-Majma/1298134516 Betsy Majma

    You will be a better doctor as a result of this experience.  When we are young and naive we feel immortal and can’t conceptualize why other “lazy” people groan and limp around- then life takes hold and we get a clue.  Sorry that your pain will be so enduring, but I hope this experience motivates and propels you forward to make whatever changes the healthcare system needs to improve….and there’s a LOT of room for improvement
    Betsy, CRNA

  • http://www.facebook.com/people/Karen-Vreeland-Kennedy/1462745158 Karen Vreeland Kennedy

    Interesting perspective from Linkedin.  It surely makes me feel better but it doesn’t change where I am. :(

  • http://twitter.com/PersonalFailure Personal Failure

    I had my appendix taken out nearly 20 years go on Easter by a heart transplant surgeon. (He was the only surgeon available, it being Easter in a nearly 100% Catholic community.) 

    He was a great surgeon, but afterwards, he tried to get me to admire his lovely incision, and told me that he did a bikini appendectomy because “a pretty girl” like me wouldn’t want a scar on my stomach. I couldn’t even express how creepy it was that he was thinking that while I was unconscious on a table, and I could not admire the gash in my own abdomen. He wouldn’t let up until I said something positive about it.

    Great surgeon, no people skills at all.

    As to pain, I have told my doctor that I actually kind of like my gallbladder attacks because the excruciating agony distracts from the far lower, but chronic, pain everywhere else. He thinks I’m crazy. He thought I just liked the morphine until I showed him my hospital bill- without any morphine on it because morphine makes me cry uncontrollably. The only reason I ever go to the ER is to have my blood pressure monitored, because it gets dangerously high during the attacks.

  • Anonymous

    Doctor D, you have just witnessed the ultimate experience, being a patient. It truly lends a different perspective, doesn’t it?

    I worked in surgery for over 25 years and saw some mighty fine surgeons, in my time. However, too many of them tended to be judgmental and pious, when it came to their patients. Since, I had been a patient 10 years before I became a Surgical Technologist, I knew better. I would frequently be the patient’s advocate, when callous comments were made, at the surgical field.

    It’s called empathy, not sympathy. When doctors, nurses and the medical staff have empathy, the patients response better and the outcome is usually excellent. What makes it so hard, is empathy can not be taught in the academic phase, you are either born with it or learn by personal experience. It is the desire of those who truly love to work in medicine, to honestly help others, in their time of need, by using all of their skills, knowledge and their humanity of understanding.

    Great blog, Doctor D!!!

  • Anonymous

    You sound like a total ass. I’ve been a nurse for 34 years and doctors like you are an embarrassment to work under. Your position on pain control is archaic and barbaric. And you totally lack dignity as you took your turn in the hosp. bed. We all come under the surgeon’s knife and we all pass through this world. 
    Grow a pair and save yourself further shame.

    • Anonymous

      My God, what a nasty attack.  Kevin, don’t you moderate comments anymore?

    • Anonymous

      Wow… nurses like you give a bad name to an otherwise (generally) compassionate profesion.  You are an outlier.

    • Anne Dare

      Boy, I hope I am never on YOUR shift, especially in the middle of the night.

  • Carol Brandt

    One of the problems most medical staff suffer from is, for the most part, their jobs are routine to them. They have seen it all before. For patients, however, these situations are new, unexpected and scary, at the very least. 

    While we patients want experienced medical staff, the lack of adequate patient perspective places significant barriers in the doctor-patient relationship. I have had numerous surgeries, and now am dealing with myeloma. The stories I could tell are both funny and tragic. 

    The problem remains that most medical staff, with exceptions, rarely acknowledge their responsibility as a partner in this relationship and to its successful outcome. 

  • http://pulse.yahoo.com/_HR345TNHOCOQCT7ZEDZJJ5PVVQ ragath

    After years of SBG testing, and shots x3 a day, I happened to complain about it to one doctor, and he said, “I tested my BS X3 yesterday and took two NS shots, no big deal.” “Really?” said I, “wow – Now do it every day for a week, then a month, then more often than x3 a day when you get “hormonal” and get pregnant or go to a party or get a BS spike cause you had a bad meeting at work, measure your food, balance the risks to benefits of anything you put in your mouth, basically, be CONSUMED by diabetes management… and then we can share stories, until then, shut the F’ up.” That’s the last time I saw him.

  • Anne Dare

    This is great! I am in the medical field myself and trying to communicate with physicians even on THEIR level is sometimes impossible. I don’t know if a different spin during all those years of schooling would change things, or does the medical field just attract “that sort of person” who disconnects from his or her patients for self-defense, or lack of people skills, or even fear of people skills?  It’s easy to forget there is another human being under that surgical drape, when all you can see is the 6 x 12 inch exposed bit of skin.  
    As for the drug prescribing part of this, patients just don’t understand they can say “no”, especially if it doesn’t help and only makes them feel worse in ways they didn’t feel before taking it.  My own physician knows I will!

  • http://www.facebook.com/people/Trudy-Harrison/100000783574465 Trudy Harrison

    I’m surprised you received pain meds.  For a truer patient experience, you would instead have received a lecture about the dangers of addiction and no meds.

    Yes, prolonged pain is terribly demoralizing, esp.when it seems you will have it for life.

  • http://pulse.yahoo.com/_AHJLBFNNBNL7SVEXJCRGWDZTBI Braidz

    Dear Dr. D,
    “I wish I could help you, but…” has proven to be a help, and a good alternative to: ““Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” (From point 5 in your list.) I have said “I wish I could help you” myself in some situations. I am not a doctor, but I work at a hospital. And at times in the past, one of my jobs has been answering the phone, There, many patients wanted a direct line in to the doctor (no message-taking!), but obviously I had to follow my instructions and page for the doctor only if the criteria for doing so were met. 

    The advantage of saying “I wish I could help you” is that it shows a true desire to help even when it is not possible. Of course, maybe you and many other of the great doctors out there are already doing this. Not every patient accepts this either. 

    In the most difficult of the above cases, I learned to say, “I don’t have the authority to make this decision.” (Still another reminder that I can’t decide here.) A doctor could also conceivably use this in some situations. After all, you can’t prescribe everything that patients could conceivably want, etc.

    I appreciate it when my doctors give me insight into WHY they cannot give me a particular treatment that I want, and I think the above is one way of doing it.

    By the way, couldn’t you transfer to a different orthopedic surgeon now that you’ve given him a chance for so long? I know it’s a bother (and an awkward situation) to ask for copies of your records so you can transfer. But it’s your life and your health. I think I would have wanted to transfer in that situation.

  • Anonymous

    After I have a bad day (and some days can be horrible), I always remind myself that it’s always better to be the doctor than the patient.

    Usually it’s best to say it aloud, it seems to be more effective when told to someone else, after recounting your day.

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    Good job, Dr. D, although I’m sorry you had to go through this. As a long-term diabetic with multiple disorders, I have had to deal with lot of doctors, and they vary a lot. Some are good listeners and some are not. Active listening should be a part of medical training (not like you don’t have enough to learn!) because sometimes the patient knows more about his disease than you do. Some of us PWDs (people with diabetes) regard our doctors only as walking prescription pads, and it really SHOULDN’T be that way!

  • http://twitter.com/RobinKD Robin Donovan

    Given that many of your hard-won observations (and truly, I shuddered when imagining your pain) have also been reported in research literature — the multi-faceted nature of pain being one that particularly stands out to me — do you think there is any way for physicians to internalize these truths without the experience of serious, personal illness or injury?  I have to believe that there is, but articles like yours sometimes surprise, or even scare, me by hinting that the lived experience of illness is inherently incomprehensible to healthy people.  It seems so important that members of the medical profession be able to understand more than the textbook side of medicine.

  • Erica Shane Hamilton

    I like this post! It does take time to come to terms with any chronic condition or disability. I’ve been there! Ten years ago, I almost died when I had a severe flare of inflammatory bowel disease, and it took a lot of hard work to attain long-term remission, which I’ve enjoyed for six years. There were some days when the pain, debilitation, and other discomforts just “sucked,” and expressing that seemed to take the load off, if only temporarily. At the same time, I am a fan of “reframing,” a coping method. I believe that nothing can really break you. If anything, your experience has made you stronger, wiser, and more compassionate. The “broken people” sometimes have something that healthy folks frequently lack, great appreciation for all that they *can* do. Since you are a doctor, you probably hear from patients most when they are experiencing phases of despair and demoralization. If you are open to it, check out the writings of Darlene Cohen, an amazing woman who lived with rheumatoid arthritis for many years, and then cancer: http://www.darlenecohen.net/welcome/way.html .

    As for the difficulties in communication between doctors and patients, I am so glad that you are bringing awareness to this important issue. I once had a job in which I trained newly hired doctors, nurses, and other health professionals in “health literacy.” The main thing I emphasized was communication, and I provided an overview of how to use non-violent communication (NVC), also known as “compassionate communication.” NVC is a wonderful tool, and more recently I’ve suggested on my blog that patients learn it too.

  • http://twitter.com/flythebike Mark Kerlin

    I had a double femur fracture in my left leg in 1995 in a serious cycling accident. I still have the full length plate in my leg. I limped for about six years. I tried really hard to rehab it, but it took about 15 years before the effects pretty much fully disappeared. You have to walk a lot, I rode my bike a lot too. Weights can help. And you can be really fit and fast on a bike but get off it and still have a limp when you walk. No way to sugar coat it, it sucks, and it takes a ton of hard work to get back to normal. Leg strength imbalance is a big problem. After awhile you learn to deal with the pain/it goes away. You just have to keep fighting, the alternative is to spend the rest of your life in a chair, probably slowly becoming obese, which is a lot worse than gaining a measure of ‘true grit’. Also, I came back from this to win a State Championship as an elite amateur in cycling…you can recover, it just takes a huge amount of work. 

  • Marie Francoise

    You are so right about pain and narcotics.

    Had a small bowel obstruction last fall, pain 8, bordering on 9 on the Mankoski Scale, but the worst was that it was unremitting for hours and hours.  What I learned from that is: when you’re in severe, ongoing pain, the entire universe shrinks to you and the pain.  Intelligent decision making is gone, you will do nearly anything to end the pain.

    Fortunately, I had this experience in France, where the pain-reliever of choice for me (pre- and port-op) was ibuprofen and a narcotic derivative that had none of the normal side effects of morphine and it’s family (which normally give me all the lovely side effects that you have described).  I was feeling almost pain-free and clear-headed within a couple of hours of my surgery.  It was amazing.

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