The difference between playing doctor and being a doctor

I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example.  Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.”   He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the next patient.  It was a moment to “play” doctor.

I find the practice of medicine, even after all these years, to be an emotional continuum between “playing doctor” and actually “being” a doctor.  Many days and moments working with patients, helping them cope with cancer, is satisfying, stimulating and interesting.   Doctor and patient connect and I learn things about myself and about living, which are remarkable, precious and privileged. I cannot imagine any other career.

However, there are times when it gets to be too much.  When one is tired, the paperwork piled to the ceiling, you are missing irreplaceable personal events, then the quality of patient interactions seems to deteriorate to completing disability forms, rescheduling already delayed procedures, rethinking diagnostic ideas, salvaging failed therapies and running late in a chaos of myriad minor delays. Then it is very hard to summon the needed insight, compassion and focus which are vital to being the kind of doctor towards which each of us strives. Then, the best you can do is “play doctor.”  When that happens, not only are you miserable, but you feel guilty because, at some level, you are a fraud.

At the start of a doctor’s career, during those first years as a student, resident and young attending, you have no idea how to connect emotionally to yourself, let along how to bond to patients or do your job.   You play doctor all the time.  You act the part of someone strange and foreign, the perfect physician, and each day you fail.  Overtime, remarkably, miraculously, after much error, uncertainty and pain, you start, just a little, to get it “right.”

You become a better technical physician; i.e. you make the right diagnoses and your treatments actually work some of the time. As important, you begin to touch the souls of your patients and they yours. At first, this happens in rare powerful moments, like a flash going off, but if you are patient that bright light shines more often.  The education of a doctor means playing less and being more.

Then, if a doctor heals through connection, he is soothed and supported by the power of the relationship and the contribution to life, which it can produce.

Nonetheless, you are just human, so those tough moments will occur, when you cannot really “be” a doctor.  Then it feels as if there is distance between you and your patients and the bond stretches, almost to breaking.  On those days, you just “do your job,” be there for the patient and suppress the loss and weariness.  Paradoxically, it is that commitment to the doctor’s role, when you are just “playing,” which marks the great doctors, because even on their weakest day they put the patient first and their own healing later.

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

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  • Michael Rack

    Excellent article. All of us physicians need to “play doctor” sometimes (usually part of the time every day). In these cases, I think it helps to be conscious of the fact and make a little extra effort to truly listen to the patient. Kicking up the effort often results in a satisfying encounter for both parties. The worst thing for a doctor to do is to be on “auto-pilot” and just try to move patients in and out.

    • DoubtfulGuest

      As a patient, I appreciate this post and your comment. Yes, the effort needs to be to connect and listen to the patient. NOT to pretend you’re having the best day ever when you’re feeling down. When I ask my doctors how they’re doing, I really mean it. I still need my medical problems addressed, but I wouldn’t mind a bit if my doctor replied “Kind of tired and…blah, today, actually” when that’s the truth. It’s okay to not be at the top of your game every moment, and I’d rather know about it so I can do my part to make the interaction go well.

      I’m not saying, heap all the responsibility on the patient…I’ve experienced the opposite where a doctor sarcastically told me he was doing “FAAAN-TASTIC!!!!” when he was in the midst of covering up one medical error and right before he made a serious misdiagnosis. No, just be honest with me, do your best to take care of me, and give me a chance to make it as easy for you as possible.

      • rbthe4th2

        Oh yes!! Thank you DG. You know, my couple of good docs, I’d like to take another chance to say how much they’ve done for me, and how I appreciate it, to make their day as much as they’ve made mine. To give them a reason to keep going.

  • Ron Smith

    Hi, James. (Sorry if I’m a little ramble below. I’m a little pressed for time or I could do a little better job I think.)

    I don’t know that there’s a problem with doing what physicians have to do. Any service professional has to put on a good smile and try to, well. serve!

    I think the issue here is probably not just one of connection either. That’s still part of the service thing I think.

    But what really helps me I think is that I really *do* care about the children I see. I don’t think medical training helps that at all. I think that requires a deeper look at ones self as a person.

    How easy it is to sit down with a very good friend, and have meaningful interaction that seems to take no notice of time. On the other hand, when we really aren’t interested in someone, we can carry on a surface conversation, and even hold in the anxiousness we’re feeling so as to not hurt their feelings.

    I think it requires spiritual depth and compassion to walk into room after room and give yourself over to the same intensity with the answers that you know like the pores on your own face.

    I find that when I feel myself slipping into answers that are less than the best I have to give, its time to refresh and regroup inside.

    This same principle is what happened before we had an empty nest. Within hours of my expression of any bad attitude, I would see my wife and children begin to show that same attitude. Patients pickup on this too.

    I don’t think the answer to this is probably with anything medical or with poor interpersonal practitioner skills.

    Warmest regards,

    Ron Smith, MD
    ron (adot) ronsmithmd (adot) com

    • rbthe4th2

      Great response. I would think it might take a bit more for a guy in peds.