Why are doctors the worst patients?

We’ve all been there. You’re in medical school, sitting in a lecture hall — maybe the course is pathology — and for the first time since starting your studies, you’re actually learning about real diseases, not just benzene rings and the Krebs cycle. You’re furiously note-taking, and you reach back to work out a kink in your neck. There it is! A palpable, enlarged lymph node. You have lymphoma. You must. Because that’s today’s class topic.

Almost ten years ago, New York Times medical reporter Abigail Zuger wrote, “If stereotypes are to be believed, one of the best ways to develop hypochondria is to enroll in medical school, and one of the best ways to get over it is to graduate.”

Though “medical school syndrome” hasn’t been well studied, some theories have explored the notion that it stems from young, healthy students being confronted by new information on disease and illness for the first time in their lives. Unaccustomed to the dense and sobering onslaught of such information, they feel vulnerable to every horrifying malady. Once they’re out of the lecture halls and a bit more inured to seeing illness, the syndrome fades.

Or does it? Let’s not underestimate the number of hypochondriacs among us maturing docs as well! In what I’d term “late stage” symptoms, it’s not learning about something new that gets us. Rather, it’s finding something in ourselves — a strangely shaped bump or an unusual constellation of symptoms — that doesn’t fit a pattern. That, I’d argue, is the perfect trigger for rejuvenating the hypochondriasis we buried at graduation.

It’s often said that doctors are the worst patients, and perhaps that’s precisely because we’re all too familiar with what it means to be sick and to have the vulnerabilities and fears of the ailing. It isn’t fun. For those same reasons, maybe we haven’t really proverbially grown out of our hypochondriasis. Maybe it’s alive and well; operating at every turn as we navigate through cancer diagnoses, pronouncements, rotten luck, and close calls.

I will never forget the time I was asked to consult on a young, male patient with generalized musculoskeletal pain. He was a husband and a father of two young children. He was in his prime. I took the patient’s history and I examined him. Then I offered to look up the results of his recent chest CT, performed because of some vague respiratory complaints. When I opened the chart, it was too late to change course. I had to tell the patient that the likeliest explanation for his symptoms was, in fact, cancer.

Vague pain one moment, and cancer the next — the odds of such discovery are incredibly low, and yet that’s exactly why they haunt me. We are justified in our occasional, unrealistic fears because we are only human, and our collective experience certainly exposes us to some very challenging things indeed.

Natalie Azar is a rheumatologist who blogs at The Doctor Blog.

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  • doc99

    I was the guy in the back of the room who thought the Krebs Cycle was Maynard’s Bike.

  • Alan Byron

    I have heard it many times: ‘Doctors are the worst patients.’ But in what sense? Is it because they ask pertinent questions difficult to answer? Is it because knowing themselves and the aetiology of their presumed disease they challenge an offered diagnosis? Is it because they are not passive recipients of their clinician’s diagnosis=best guess? I have often found that consultants are expert in their own fields and are quite blind to possibilities in other fields.They frequently do not carry our totally comprehensive clinical examinations because they are incapable of interpreting the results, except within the narrow field of their specialty.I found a nephrologist totally deny that a rise in pulse and blood pressure on effort could cause my toes to hemorrhage even though I had incontrovertible evidence that it did. Since being on beta blockers the problem has stopped.As a generalist with very wide experience my opinion is never canvassed. So, the fact remains that being a ‘worst patient’ really means one who challenges conventional wisdom.

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