Special Considerations in the Care of the Physician-Patient: a Lesson for Medical Education

Abstract

In the field of medicine, there is strong emphasis on the healing of others, but not as much on the healing of self. It is therefore not surprising that physicians may be ill-equipped to not only care for other physicians, but to be treated as patients. Multiple studies indicate that relatively few physicians have their own primary physicians and often rely on self-treatment, rather than obtaining comprehensive care from other physicians. Through the lens of a personal struggle with serious illness, the author develops a discussion about potential barriers physicians face in seeking care, the downstream effects of physicians’ perceptions of health care, and ways to make changes to prevailing physician health attitudes. Potential changes at the undergraduate, graduate, and continuing medical education levels are considered, in order to help physicians both to embrace their roles as patients and also better serve their colleagues who are under their care.

APPENDIX 1. Factors to Consider in Treating Physician-Patients

Physician-Patient Factors

• Delay of care: recognize that physician-patients may minimize and rationalize symptoms to avoid appearing “weak” and also to suppress subconscious fears of being ill.

• Sense of duty: realize that physician-patients may place patient and colleague needs before personal health needs.

• Self-doctoring: understand the inherent motivations for physician-patients to self-treat, including expediency and desire to avoid inconvenience for fellow physicians.

• Directing own care: appreciate the difficulties that physician-patients experience in embracing the patient role, leading to the tendency to continue to attempt to exert medical control over personal illness as a physician.

Treating Physician Factors

• VIP syndrome: recognize positive reactions of fellow providers toward physician patient (prioritized for procedures, special attention) and negative reactions of fellow providers toward physician patient (perceived preferential treatment).

• Presumption of knowledge: be aware of tendency for treating physicians to speak in medical jargon, counsel less and assume familiarity with procedures and treatment when caring for physician-patients.

• Excessive deference: understand inclinations of providers to attempt to “spare” physician-patients from embarrassing procedures, while not making firm recommendations on treatment and tending to elevate the physician-patient into a relatively greater role within the provider-patient relationship than non-physician patients.