The Clinician as Patient

Two years ago, 30 days after delivering my newborn, I experienced painful and profound hemorrhage, so severe that I was petrified to make the slightest movement. As my husband drove me to the ER, my entire life flashed before my eyes,  and I thought I’d never make it back to my newborn. In my head, I ran a list of differential diagnoses and went through their prognoses. I was wheeled into the ER and became the patient laying half-naked on a gurney and being pushed to the OR. I was diagnosed with a retained placenta that had led to secondary post-partum hemorrhage. My lived experience informed me about the vulnerabilities of a patient navigating our healthcare system. It also made me reflect on my interactions as a physician-patient with the treating doctor.

At some point in our lives, we become the patient at the other side of the conversation, the one receiving care. It may be for preventative screenings or seeking medical care for acute/chronic medical conditions. It can be unnerving, humbling, and an eye-opening experience. There are some powerful memoirs written on this topic by prolific physician-authors like Dr. Rana Awdish’s “In Shock,” Dr. Paul Kalanithi’s “When Breath Becomes Air,” Dr. Jerome Groopman’s “How Doctors Think,” and Dr. David Fajgenbaum’s “Chasing My Cure Among Many Others.” All of these books are about their challenges as a patient.

The expectations and considerations of a clinical encounter between a treating doctor and a physician-patient are unique. When the clinician presents as a patient, his or her proficient health literacy will facilitate or impede a diagnosis and management. For the most part, clinicians can create comfortable relationships with their peers, but sometimes boundaries can become blurred. Open communication is key to preventing this.

Here are some strategies to navigate scenarios between a clinician-patient and a treating clinician:

For the clinician as a patient:

1. Embrace being a patient and trust the expertise of your clinician.

2.Use your knowledge and experience to navigate your medical condition and clearly communicate your goals of care and preferences. Don’t interfere with the management of the clinical care team, it can lead to over-testing and over-diagnosis.

For the treating clinician:

1. Make sure your clinician-patient has a primary care provider.

2. As usual, document all clinical encounters in their electronic health records—no “curbside consults.”

3. Let go of any assumptions you have about them professionally to create a non-judgmental and non-biased environment.

4. Leverage your patient’s health literacy. Engage in a shared and nuanced discussion of diagnosis and management.

5. As always, consider the emotional needs of your patient.

These strategies are neither exhaustive nor perfect and must be adjusted on a case-by-case basis. Practicing open communication will create deep and comfortable relationships to achieve goal-concordant care.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.