Jane McCredie: Tough lessons

“I AM a senior physician with over six decades of experience who has observed his share of critical illness — but only from the doctor’s perspective”, writes Dr Arnold Relman in last week’s New York Review of Books.

That all changed when Dr Relman broke his neck in a fall at the age of 90, leading to an emergency tracheotomy, repeated cardiac arrests and months of rehabilitation.

“I learned how it feels to be a helpless patient close to death”, writes the Harvard professor and former editor of the New England Journal of Medicine.

Among the insights Dr Relman* gained were a greater appreciation of the importance of good nursing care for patient wellbeing, the crucial need to have a single doctor (preferably the patient’s GP) coordinating care, and the inconsistencies in quality of care between different US institutions.

He was also concerned about the quality of electronic health records kept by some of his doctors, “full of repetitious boilerplate language and lab data, but lacking in coherent descriptions of my medical progress, or my complaints and state of mind”.

There’s no question that doctors can learn an enormous amount about the health care system and their own clinical practice from becoming patients.

Closer to home, Melbourne oncologist Dr Ranjana Srivastava has written about the experience of becoming a patient when her unborn twins died as a result of twin to twin transfusion syndrome.

“I have seen this room a hundred times but never its ceiling”, she writes of being wheeled into the operating theatre to have the babies induced.

When she refuses to be intubated for the procedure, the anaesthetist is clearly annoyed, casting her “as yet another difficult patient wanting to play doctor”.

Being on the other end of the stethoscope can certainly shift doctors’ perceptions, particularly perhaps a view of non-compliant patients as an unwelcome irritation.

A paediatrician once told me about the distress he felt accompanying a young grandchild with multiple health problems to medical appointments and how it had given him new understanding of some of the more “difficult” parents of his own patients.

US psychiatrist Dr Robert Klitzman is another who felt he gained new insights into patients after plunging into depression following his sister’s death in the 2001 collapse of the World Trade Center.

“I felt weak and ashamed, and began to appreciate, too, the embarrassment and stigma my patients felt”, he writes in his book, When Doctors Become Patients.

Dr Klitzman interviewed more than 70 doctors for the book, including a gastroenterologist who had no idea what patients meant when they described their abdominal pain until she developed it herself.

Then there was the surgeon who realised for the first time after undergoing surgery himself what a big difference there was between telling a patient they had a 5% chance of dying during an operation or saying they had a 95% chance of survival.

A common thread in these doctors’ accounts is the way their experience as a patient has made them a better doctor.

“I realized that I, as a doctor, would never be the same, or look in the same way at the problems that patients and their families faced concerning depression or grief”, Dr Klitzman writes. “The difficulties were far more complicated and long-lasting than I had ever imagined…”

There are some things you can’t teach in medical school.

Jane McCredie is a Sydney-based science and medicine writer.

* Dr Relman’s determination to continue his ongoing commentary on the US health system can be seen in the photo accompanying his article. In the immediate aftermath of his devastating fall, he sits propped up in the surgical ICU while his wife, Dr Marcia Angell, another former editor of the New England Journal of Medicine, helps him correct proofs of an article he has written on Obamacare.