Physician, don’t heal thyself

A couple of months ago, I was dragging a large suitcase that got hung up on a curb, giving my arm and shoulder a good yank.  Over the next few days, my shoulder began to ache a bit.  Applying the very reasonable ‘tincture of time’ principle, I rested it a bit, hoping that with time the symptoms would resolve.  Two months later, I was getting an MRI and anticipating surgery for a torn rotator cuff that would turn me into a disabled dependent, relying on my non-dominant hand and my wife to help me with everyday tasks, including driving and getting into and out of shirts and a bulky shoulder immobilizer for three months.  The good news: the MRI showed no tears, so I did not need surgery.   The bad news:  I was the victim of my own mismanagement, and had a partially frozen shoulder, requiring a few months of rehab and daily, uncomfortable stretching.  This probably could have been completely avoided.

Patients’ responses to illness or injury range from absolute indifference to reasonable concern to excessive, even debilitating fear.  The physician’s role includes helping the patient compensate, if necessary, for their inclination to respond in less than healthful ways to the insult, aligning with what they need rather than getting caught up in what they usually do.  When a physician is his own patient, however, it is often difficult to practice this particular art without blurring the distinctions between their “patient personality” and their “physician persona.”  That is why today I have a stiff, sore shoulder pumped full of Kenalog.

It is easy to understand why physicians often resort to “healing themselves.”  It is easier, faster, less expensive (sometimes), and less disruptive to a physician’s busy schedule to treat your own sinusitis, wrap your own sprain, prescribe your own anti-hypertensives, medicate your own migraine, or diagnose your own rash.  Most of the time, this approach works, more or less, and consequently many physicians don’t even have their own primary care provider, especially when they are young.  They just have the proverbial fool for a patient.  I have a primary care provider, but that didn’t keep me from relying on what I was inclined to do as a too-well-informed patient, rather than relying on my own physician’s considerable skills.   I hope I have learned my lesson, but that remains to be seen.

If you are your own physician, draw a distinct line at readily apparent, short term, minor illness or injury, and find a good provider to rely on when you slip over that line.

Myles Riner is an emergency physician who blogs at The Fickle Finger.

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  • Anonymous

    I’m a medical sociologist, not a physician, but am surprised that Dr. Riner believed that if he had a torn rotator cuff he’d need surgery.  I had multiple tears in both cuffs and had been successfully treated with physical therapy, NSAIDS, and a cortisone shot.  It took a few months, but the treatment is much less invasive, risky, and expensive than surgery!  If you had surgery, you’d still need PT — as you mentioned, surgery would leave you disabled for 3 months!  So why not go the conservative route for a torn rotator cuff in the first place?  Anyway, glad it was only a frozen shoulder, but the best treatment — and outcome —  probably would have been the same had it been a tear.

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