Physician Wellness Jun 2008: The experience of illness

PHYSICIAN WELLNESS

The experience of illness
Doctors who become patients can teach each
other how to accept care

by Monique Camerlain, MD

Proudly, I contemplated my "new look" in the hairdresser's hand-held mirror -- while at the same time, I shivered.

I envisioned the day, a year before, when that lock of hair had fallen in the soup, confirming that I'd have to wear a wig. There was no way I could deny this side effect of chemotherapy. I had breast cancer, and cancer is cancer even if you are a doctor. For the first time, I'd allowed myself to cry and finally face how scared I really was.

After living through surgery, chemo- and radiotherapy, I was a cancer survivor, and today, I had a great new look! I'd been through hell and back and -- perhaps -- was healed. My hair had grown back and I was progressively moving from post-traumatic stress to post-traumatic growth. "If it doesn't kill you, it makes you stronger," says the popular Viking proverb. I felt as if I could, again, move through the looking glass into the world of the physician, my true universe. I knew, however, that I'd always carry within me the memory of the other side -- having been the patient, I would never be the same.

I thanked the hairdresser and happily walked out into the noonday sun, as it reflected the auburn highlights of my gorgeous hair! Yes, I'd grown as a person and as a doctor. All through the ordeal, trust and hope had kept me going and having experienced that "other side" -- having come face-to-face with my own fears of illness and mortality -- I'd learned the true definitions of hope and trust, along with the capability of a deeper empathy.

As stated in the publisher's description of Robert Klitzman's When Doctors Become Patients: "For many doctors, their role as powerful healer precludes thoughts of ever getting sick themselves. When they do, it initiates a profound shift of awareness -- not only in their sense of their selves, which is invariably bound up with the invincible doctor' role, but in the way that they view their patients and the doctor-patient relationship."

"I'm not afraid of death; I just don't want to be there when it happens," Woody Allen once quipped. Physicians understand this humour. It's one of our defence mechanisms. We also tend to be adept at denial. In the midst of illness and death, many of us have a deep-seated need to believe, or try to believe, that we're immune to human frailties. Daily, we must face the truth of John Brown's saying, "It is not a case we are treating; it is a living, palpitating, alas, too often suffering fellow creature."

The worst patients
Physicians are said to make the worst patients. Perhaps this is because the dynamic processes related to clinical roles and relationships affect us differently when we ourselves become the "suffering creature." We can't, or won't, behave as a layperson because of our knowledge, experience and even status among colleagues. We can't be weak and needy without feeling shame. Voltaire once said, "I know of nothing more laughable than a doctor who does not die of old age." And so, doctors have learned to distance themselves from the ill, to create a world of "them and us" with the white coat as frontier. I, too, had difficulty joining other women in a class on make-up for breast cancer patients. Yet, as we learned to tie a scarf, choose a wig, draw the line of an eyebrow, I became "one of us" -- just me -- a person learning the tools of self-respect and self-efficacy, a mere human being trying to cope.

"When doctors get sick, they discover fissures in the health system that they didn't know existed," writes Tara Parker-Pope in the New York Times. "They learn that seemingly small annoyances they never paid attention to as doctors -- like long waiting times or a broken television in a hospital room -- really are a big deal when you're the patient." I also learned a lot about communication failures as I patiently sat and listened to conversations in numerous waiting rooms. But more importantly, after abandoning my white coat to become "a part of them" or better still, "one of us," I mastered the ability to confide, trust and hope. I learned the flip side of evaluating risk-benefit ratios, the meaning of compliance, the difficulty of coping and adapting to a new reality.

"Even doctors who thought of themselves as compassionate recognize they can do better once they experience life as a patient," writes Parker-Pope. I feel there is another important aspect: peer-to-peer education. By sharing our stories as doctors who become patients, we can give each other lessons on how "the powerful healer," "the invincible doctor" is allowed, without shame, to become someone in need of others, and of care. I have gone through the looking glass and discovered another me on the other side.