When Doctors Become Patients

Este texto original.

Personalmente, digo: Cuando el médico es paciente, la relación siempre se intermedia con "el consentimiento informado", legislado.

When Doctors Become Patients

It's the irony of professions: the financial planner goes broke, the lawyer is sued, and the doctor gets sick. This interesting book is an under-the-microscope dissection of medical practice, the experience of being ill, and interactions that physicians who are also patients report having with their physicians. The goal of When Doctors Become Patients is to provide a better understanding of the complex relationships between physicians and patients by highlighting the unique situation of the sick doctor, with a focus on power, dignity, denial, errors, guilt, communication, authority, professional boundaries, dependency, emotional distance, and the interpretation of numbers (laboratory test results and statistics that predict outcome).

After experiencing a life-changing but fortunately brief illness, Robert Klitzman, a psychiatrist, interviewed 70 patients, and in his book he presents their reactions to being on the other side of the medical divide. Many of the interviewees were relatively young, with much of their professional careers ahead of them. Half were infected with HIV, rendering the sample somewhat skewed, and the others had been given a variety of serious medical diagnoses. Both men and women were included. It is not clear how the interviews were structured, but Klitzman has organized the responses of the interviewees around specific themes and subthemes, and he uses the stories of the physician–patients to illustrate them. It would be a mistake to dismiss his findings as unscientific, because a great strength of the book lies in the richness of the patients' words, through which the reader learns firsthand that illness is transforming and that “human lives are messy and complex.”

Any physician who has had the misfortune of having a serious disease will recognize the reactions, emotions, frustrations, and rewards that are expressed by those who were interviewed for this book. As Klitzman and his interviewees describe, illness strips away pretenses, exposing core issues of what is important for physicians when they become patients, issues of self-identity and professional responsibility, and issues of blurred boundaries between patients and physicians and between professional and personal thoughts and actions.

The book's value rests in how Klitzman portrays the broad spectrum of physicians' responses to their own illnesses and describes strong commonalities at the same time. It affords physicians an opportunity to view themselves from the point of view of colleagues who are also patients. Access to the actual words of the physician–patients leaves the reader deeply touched by their humanness. Clearly, the observations concerning the experience of illness that are detailed in the book extend beyond physician–patients to all patients.

On the other hand, the book's narrative is somewhat jerky and repetitive. Certain concepts (such as magical thinking) appear again and again, and the patients' identifying characteristics (their identities have been masked by the author) are repeated many times to allow the reader to keep track of them. Klitzman summarizes and interprets the responses of the interviewees in ways that sometimes interfere with the power of the patients' own words. Unlike the words of the interviewees, the summarizing narrative risks making the patients difficult for readers to like or regard as sympathetic, and Klitzman's directive style robs readers of the opportunity to base their conclusions on what the interviewees themselves say.

The overriding message of When Doctors Become Patients is that a profound understanding of what it means to be a patient can be gained by listening to physicians who have become ill. The book ends with probing questions: Can heightened awareness of a patient's true situation be taught? How much empathy on the part of a physician toward a patient is too much? In the physician–patient relationship, who is taking care of whom? When is power, which is inherently held by physicians, good? When is it bad? This analysis — and in fact, the entire book — goes to the very heart of the question of what a physician is. The answer comes into acute focus when physicians are faced with their own illness and all its physical, emotional, philosophical, professional, financial, moral, spiritual, and ethical complications.