C L O S L E R
Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

6 Lessons From 12 Years as a Patient-Doctor

Takeaway

Our white coats are not shields; they could be traded in for a flimsy hospital gown at any moment. Keeping this in mind, we can think of how we want to be cared for when our time comes, and then give this level of care to others. We can honor our shared humanity and vulnerability in our practice.

I arrived in my scrubs. My head rang with the cacophony of the past 26 hours – the intubation blade’s clang as it dropped onto tile floor, the slick thwap of the umbilical cord being cut, the gurgly first cry of a 28-week old infant, the incessant staccato of the delivery pager.

 

The ordered routine of the MRI suite was calming. Bleary-eyed, I shoved my hospital badge and pager into my tote bag. The MRI tech gave me a puzzled gaze; I was wearing an unusual outfit for a patient.

 

“I’m a resident here,” I said.

 

“Oh, ok Doc. Do you want to change into our scrubs?”

 

I traded light blue for light green and an oddly cut wrap-around robe I fastened incorrectly.

 

Swaddled in warm blankets and a plastic exoskeleton, I entered the tunnel.

 

After having several dozen MRIs in my life with cancer, the buzz and hum of the machine’s magnet had become soothing.  Cocooned, I sang along, trying to create a symphony.

 

I thought of the babies I’d just left in the NICU. Did they sing along to their monitor’s beeps?  Were they comfortable in their plastic cocoons?

 

Soon I was home, trying to sleep and flush out the contrast, burying my anxiety. I would be back in the NICU soon.

 

I was diagnosed with liposarcoma just before I became a medical student; it recurred in medical school, and again in residency. I learned not just when to order an MRI, but how to describe its cramped warmth, loud bleeps, and whirs. To understand not just the findings of a biopsy, but how to endure the endless time awaiting its result. To decide not only which treatment is indicated, but to have felt the unbearable nausea or searing pain it causes.

 

I wear both the patient gown and the white coat.
I’ve scrubbed into surgeries and been operated on myself. I’ve been told, “I’m sorry, the mass is malignant,” and given the same life-changing news to others. Like a curling strand of DNA, I exist in parallels. As doctors, we often feel we are “other” – somehow different from our patients. I have never been able to achieve such separation.

 

Our academic degrees give us knowledge, but they do not confer superhuman powers. We, too, are vulnerable; we, too, suffer. I can recite the cascade of proteins that make the blood clot, but I bleed no differently. I can explain the genetic changes that cause cancer, but my genes still mutate. I can discuss survival rates, yet I can do little to lengthen my own life.

 

Our white coats are not impregnable shields; they could be traded in for a flimsy hospital gown at any moment. If we keep this in mind, we can think of how we want to be cared for when our time comes, and then give this level of care to others. We can honor our shared humanity and vulnerability in our practice.

 

Lessons I’ve learned in a dozen years as a patient-doctor:

 

1.) What is routine for us as physicians is rarely routine for patients – explain more, be patient, address worry or confusion.

 

2.) Give important results as soon as possible; waiting for results is agonizing for patients.

 

3.) Always ask patients what worries them the most – it is often not what you assumed.

 

4.) Address the psychosocial aspects of illness explicitly.

 

5.) Illness is just one part of your patient’s life – it defines them in the medical space, but less so in the broader context of their life and their world

 

6.) Think about how you want to be treated when it’s your turn in the flimsy hospital gown; then treat every one of your patients that way.