Taking care of other physicians and their families

Terry is a particularly difficult patient.  She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff.  No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult man.

Terry’s husband loves Terry very much.  He wants her to have the very best care.  Dr. P makes certain that all the doctors know everything that is going on, all the time; he makes sure the nurses are on top of every detail; he demands the best from the all the hospital staff.  In fact, Dr P works so hard to control Terry’s care, to stay on top of her case, to monitor every moment, it is nearly impossible to take care of Terry.

There are many challenges for doctors taking care of other doctors or their families, or, in reverse, there are many challenges for doctors when they seek care for themselves and their families.  The result of this conflict is often inferior medical care.  Therefore, wanting to honor and help doctors get good quality treatment let us take a moment to review the doctor verses doctor verses medical system dilemma.

First, it is hard for doctors to decide where to go for medical care.  If you stay in the same community where you practice you lose some privacy and perhaps even respect in the physician community.  Who do you chose and how do you avoid offending the other physicians you do not use?  If you leave your own area, you lose the convenience and familiarity of getting care close to home.

Next, there is the tendency of physicians treating other physicians to give “special” care.  The problem is that when we give special care, we deviate from training and protocol.  When we deviate, we make mistakes. “Sure Dr Bob, your wife’s chest pain doesn’t sound like much so instead of dealing with the emergency room come by the office after-hours.”  Years of training and experience, which produce professional judgment and wisdom, are thrown out the window to be polite and go that “extra mile.”  The problem is that a mile may be too far.

Physicians and the medical system tend to treat doctors as, well, as doctors.  We expect them to understand issues faster and have a sophisticated interpretation of events.  We talk with them in medical-ease and assume they will cope the same way as when taking care of their own patients.  I have seen physician spouses invited to join MICU rounds involving their loved one.

If a physician’s significant other is ill, there are always issues of guilt.  “I discovered it too late”;  “the medicine was not enough”;  “I was not persistent or was too persistent”;  “I should never have written that script”. This layer of guilt adds to the emotional burden of illness, and can lead to anger, confusion, and complicated grief.  Attempting to assuage their own guilt physicians seize control of their loved one’s care, whether or not they have medical knowledge, with the result that the patient suffers.

The solution to all of these problems is essentially the same, but can be hard for naturally controlling physicians to handle.  The answer is that a physician-patient is a patient, not a physician. A doctor of a loved one is not a doctor at all; they are family.  Just as other patients must adjust to medical care and systems, assuming the “sick role” in order to get the best care, physicians must assume the proper role of patient and family.

Physicians should pick their doctors purely on the grounds of getting the best care; no other measure is proper.  Other doctors and the medical system must treat physicians as patients.  That means we use the same systems, the same protocols and the same approach as we would in any similar case.  It means explaining medical events like you are talking to any layman, as if the doctor has no medical training.  It is reasonable to use basic medical terms and concepts to communicate but to assume that a physician under personal or family medical attack can understand complex health concepts is to risk confusion and a bad outcome.

A doctor’s emotional circuits fry as fast as anyone else and they can rapidly become saturated.  Doctors have seen every bad outcome and will often fear the worst, thus they may over react to minor setbacks. They may even give up when continued care is warranted.  This extra layer of complexity is born out of the doctor’s years of emotional adjustment to disease, which in this situation may be counter productive; it must be anticipated and discussed.  Paradoxically, physicians may be less able to cope with health care and need more support than a patient who has never before set foot in a hospital.

Doctors should not be allowed to take control of the care of loved ones and in reverse should not demand real control, beyond that guaranteed to each patient and family.  Treating physicians must be aware of potential guilt that can lead to controlling behavior and remember that improper control can amplify future guilt.

When a doctor or his family is ill they are patient or loved one.  This is a special role that no one else can fill and is vital.  By helping physician-patients focus on healing and not being responsible for care, we make the chance that they will return to healthy lives that much greater.  For our friends and colleagues there can be no finer honor.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • Suzi Q 38

    What do you want them to do, treat their own families???
    My question is: “Do they get V.I.P. status, or are they treated as callously noncholantly as us regular “people?”

  • http://www.ausmed.us/curriculum.php International Medical Schools

    Absolutely Reality has been presented in this article. The doctors specially those who provide their services far from their native place and family need to work very hard in personal life to make everything good………

  • http://www.facebook.com/shirie.leng Shirie Leng

    I agree and disagree on this. I’m an anesthesiologist, and when my second child was born with a diaphragmatic defect I used every connection and trick I could think of to get the best care for her I could. I had to push and push to get things done for her. I don’t know what families do who don’t know and/or cannot work the system. I’m sure we got out of the hospital a week earlier than we would have had I not used my MD when it counted. I think it’s not so much that physicians need to be treated like everyone else as it is that all patients should be treated like someone special.

    • Suzi Q 38

      I agree.
      I push and push too, and still have difficulties.
      For example, I had a surgery about 10 days ago.
      The doctor released me a day after my surgery.
      I came home and it was very swollen at the incision site, but no oozing and I did not have a fever. It has been about 10 days, and this has not improved.
      I called the doctors office and asked if I should come in.
      No one called me back. This scenario happened twice.

      I decided to take a picture of it with my iphone and send it in to the receptionist.
      I wrote about what my problem was and that I wanted someone to call me back to tell me” all was well or stop by as soon as possible.”
      I asked the receptionist to send my note to the doctor and to the NP.

      It is amazing….I got a phone call from the NP within an hour.
      she told me that the incision looked normal and that I could wait to come in. That February 6 was just fine.

      I loved it, because now I can not worry about it and just rest.

      Normally, in the past, it would take a couple of days for a callback, or no one would call me back.
      My request for a call ended with the N.P’s voicemail.

      Now I have figured out the the receptionist may be helpful as well.

  • Jean E. Howard, MD

    To Dr.Salwitz re your blog on taking care of other
    physicians and their families. I am a physician patient with lymphoma. I am BC
    in heme/onc and IM. I disagree with
    almost everything you said. To begin with the issues involving families are
    very different than those involving the physician patient so different that the two should not
    be discussed in the same article. By doing so you made you blog a scrambled
    mess. Your concepts are antiquated. Predictably, I am focused on the treatment of
    the physician patient which is terrible. If Sunrise agreed to publish my statement
    I would be happy to write a blog concerning my experiences and opinions.

    • Suzi Q 38

      You make a good point.
      I am sorry that you are facing lymphoma.
      Please share your experiences.

      I would like to know this:

      Do you go out of your area to get anonymous care?
      If you do, do you say that your name is Jean Howard, or do you use your title..Jean Howard, MD????

      I challenge all of you physicians facing a serious medical condition to give this a try. See how far you get and how much gets done for you.
      Better yet, pick out a physician from a list. Not a colleague’s referral, but a regular list from the Yellow pages on the internet.

      You will get some true surprises both negative and positive.
      Imagine you are a patient, with little medical knowledge of your own condition. You do not ask for any tests or procedures that you know from a medical standpoint that may make a difference in your outcome or save your life.

      See what they do for you on their own……very litte.

      As fo me, with no MD next to my name, I have gotten 60% so-so treatment, 20% really bad treatment…borderline stupidity or negligence. On the bright side, I have gotten 20% really good treatment.

      For me a 60% + 20% of so-so to bad treatment for the last 2 years, could have and may still render me paralyzed. I still have hopes of a happy ending for me. In spite of the uphill battle I face with getting decent and good doctors that give a care.

      I have had to study my condition myself to make sure that my doctors are on the right path. Doctors directly ask me what I do for a living, because my questions about OPLL are too detailed for most patients.
      Imagine just leaving all of your care to the health professionals and doctors without asking much.

      Trust them like we have to trust them.

      I have learned to listen to the other medical professionals, too.
      The PT therapists that thought it was nerve early on.
      They were too fearful to rattle the cage of the big neurologist at their teaching hospital and demand a full MRI.
      They tried to get me to do it, and I did try, but I got rebuffed by the doctor who told me that a full MRI and nerve tests were not needed.

      Had he done the full MRI it would have disclosed the spinal stenosis right away and saved me from two years of oh so gradual paralysis in my legs and arms.

      My question is this? If the PT has an opinion, why does the neurologist not welcome that opinion?
      I think that there should not only be more communication;
      but an atmosphere in which the other hospital specialists can meet with the doctor to discuss my care.

      Nothing remotely of the sort happened.

      Good luck to you.

  • Molly_Rn

    When the head of radiology had a small stroke and was admitted to ICU he had a fairly uneventful evening and as I was checking him (vitals, neuro checks, etc.) at the end of my swing shift, he suddenly said: “You wouldn’t happen to have any good old
    fashion nursing advice on strokes would you?” It took me by surprise and I sat next to his bed and we talked well into the next shift. He told me that everything he knew about neuro he seemed to have forgotten and he was afraid and felt foolish and was afraid to tell anyone how he felt. Great learning experience for both of us. Over the days he spent in ICU, I did my best to keep
    him apprised of everything and helped him to understand everything. I also made time to listen to his fears and concerns about his future and his abilities to practice his specialty. I also realized that we are really most confident in our chosen area and once outside of that specialty are almost as lost as the next guy. I know next to nothing about dermatology as it is not an issue in
    critical care unless you are talking about lupus or scleroderma. People, even other physicians and nurses, think you are supposed to not have those fears and feelings. I do believe that this really hurts physician or nurse patients.

    • Suzi Q 38

      I am glad to see that people are different.
      He asked for help, and you being flattered that here a physician was asking you for help gave him all the time in the world.
      My FIL was not a physician, and he had had 3 major strokes that I knew of.
      I was not sure of what a stroke was at the time. I asked nurses and was given a brochure. The doctors wouldn’t give me much information or hope, as my FIL was 72 and a total lift.

      I remember them saying that they would not know what would happen, but be happy with this nursing home that they were going to send him to.

      I asked about a really good head injury physical therapy and rehabilitation hospital which happened to be in our city. It was state of the art and nationally recognized. The doctor said that his HMO medicare type of insurance would never pay for it. Why??? He hinted at his age and type of stroke.

      I was so livid that I almost had a “stroke.”
      I decided to first ask, then insist that he be sent to the fancy rehabilitation center. The doctor agreed to write the order, but warned me that it would not get approved.

      When the insurance company called to say that my request was denied, I was ready with an answer for them.

      He ended up going to that rehab center for 6 weeks.
      I told them that they should not deny him good care just because of his age.

      • Molly_Rn

        I wasn’t flattered; my husband is a doc and a regular human being just like me. I was surprised that this patient was afraid and although a physician didn’t remember his neuro education. You just assume that physicians and nurses should understand what is wrong with them and not need that sort of help. It was stupid of me to not realize that as a frightened ill person that he would need the same help as anyone else. I gave him the same attention that I gave all of my patients. Have held patients’ hands while they died or wept or just needed to talk. You don’t know me so don’t presume that you know how I treat my patients. I was trying to get across that because physicians and nurses are people first, we also can be afraid, feel helpless, forget everything in our fear and need the same consideration as other patients. I am sorry that you had a horrible experience. It is difficult to be your loved ones advocate. Being the patient’s advocate is (I believe) part of my job as their nurse.

        • Suzi Q 38

          I am glad that you give this care to all of your patients.
          Yes, I have not had good experiences.
          On the other hand, there have been some good doctors and nurses.
          They just have been harder to find.