THE DOCTOR AS PATIENT: SPECIAL DIFFICULTIES
OR THE SAME AS EVERYONE ELSE?
An interactive session for hematologists
The practice of medicine is a demanding profession and some doctors feel
that their medical competence is partly defined by their own health and
fitness. As a result doctors with serious symptoms may attempt to show a
healthy image while concealing internal feelings of fear and denial. Doctors
may also feel guilty about taking time off to seek medical advice by formal
channels and try to rely on ‘corridor consultations’ with colleagues which
are clinically unsatisfactory and which may result in false reassurance to
the patient.
It is an honor to be consulted by a colleague about his medical concerns,
but the resulting clinical relationship may present problems which are not
associated with other consultations. The ‘doctor-patient’ may be apprehensive
because of concerns about the preservation of confidentiality when he seeks
a consultation within the institution where he works, while the consulted
doctor who sees a doctor-patient at a separate institution may face concerns
about his ability to deliver adequate care if an emergency arises. Some
doctor-patients will have experience of the speciality in which their condition
lies and may approach the consultation with a diagnosis and treatment plan
already in their minds; this plan may or may not be appropriate, and the
treating physician must hold firmly to his usual professional standards.
The treating clinician may also feel that there is an extra expectation to
deliver a successful outcome above and beyond the usual standards for
other patients. Once treatment has been initiated it is common for doctorpatients
to self-prescribe and adjust doses of prescribed medication without
informing their physician. If the doctor-patient is able to feel in control of
their illness and has entered a comfortable partnership with their physician
the effects of this behavior can be reduced.
Doctors find it difficult to be patients, and understandably expect to receive
the support and professional attention which are the rights of all patients. Most
doctors will say, if asked, that they only want to be treated in the same way
as any other patient – not necessarily better, but certainly no worse.
FACULTY
S. Johnson (Taunton, United Kingdom)
G. Jackson (Newcastle, United Kingdom)
P. Alton (Frimley Park, United Kingdom)
PROGRAM
WELCOME: AIM OF MEETING
S. Johnson (Taunton, United Kingdom)
RULES OF ENGAGEMENT
S. Johnson (Taunton, United Kingdom)
CASE STUDY
Your colleague from the Ear, Nose and Throat department (who has frequently provided you with a biopsy service for cervical lymph nodes) developed mid-thoracic back pain six months ago. He self-medicated with non-steroidal anti-inflammatory drugs for several weeks then discussed his symptoms with an orthopedic colleague over the lunch table before visiting a chiropractor who arranged an X-ray, which showed a minor degree of wedge collapse of T6. The chiropractor notified the patient’s general practitioner who asked him to make an appointment, but he delayed doing this because of a planned holiday. It was only three weeks ago when bloods from the GP arrived in the laboratory and showed a normocytic anemia with a raised viscosity, and the GP consulted you by telephone. You requested further investigations which showed an IgA kappa paraprotein of 32 g/l and a serum creatinine of 188 micromol/l. (normal range 60-120) and saw him for an initial consultation in the hospital last week. A bone marrow taken on that occasion reveals 45% plasma cells, and he has now had a skeletal survey showing osteoporosis throughout the vertebral column but no lytic lesions. He has come to clinic today with his wife. He is aware that he may have myeloma but awaits confirmation of the diagnosis and a discussion of the treatment options.
CLINICAL CONSULTATION
G. Jackson (Newcastle, United Kingdom)
DISCUSSION AND FEEDBACK
S. Johnson (Taunton, United Kingdom)
THE DOCTOR-PATIENT: LESSONS FOR CLINICAL PRACTICE
P. Alton (Frimley Park, United Kingdom)
CONCLUSIONS
S. Johnson (Taunton, United Kingdom)
