The Physician as Patient Lessons from the Other

The Physician as Patient: Lessons from the Other End of the Stethoscope Society of Teachers of Family Medicine Annual Spring Conference April 25, 2010 Jeffrey J. Cain, M. D.

The Physician as Patient • Surviving • Healing • Thriving

Physician Traits JAMA 2003 “On the Other End of the Stethoscope”

Physician Traits Personal Sacrifice

Physician Traits Personal Sacrifice Authority

Physician Traits Personal Sacrifice Authority Control

Physician Traits Personal Sacrifice Authority Control Stoicism

Physician Traits Personal Sacrifice Authority Control Stoicism Self Reliance

Physician Traits Personal Sacrifice Authority Control Stoicism Self Reliance (No Complaining Allowed)

Losses for Physicians with Illness JAMA 1998 “Doctoring Physicians and Their Families”

Losses for Physicians with Illness • Privacy

Losses for Physicians with Illness • Privacy • Medical authority

Losses for Physicians with Illness • Privacy • Medical authority • Emotional detachment

Losses for Physicians with Illness • • Privacy Medical authority Emotional detachment Objectivity

Losses for Physicians with Illness • • • Privacy Medical authority Emotional detachment Objectivity Control

Physicians When Ill Lancet 2009 “Physician Wellness”

Physicians When Ill • Fear loss of self-esteem

Physicians When Ill • Fear loss of self-esteem • Are reluctant to place personal needs above patients and colleagues

Physicians When Ill • Fear loss of self-esteem • Are reluctant to place personal needs above patients and colleagues • Asking for help is a sign of weakness

Physicians When Ill • Fear loss of self-esteem • Are reluctant to place personal needs above patients and colleagues • Asking for help is a sign of weakness • Lack of experience with illness

Physician Fears • Dependency • Disability • Death

The Physician as Patient • Surviving • Healing • Thriving

Doctors Make the…

Doctors Make the… …. Worst Patients Ann Intern Med 1983 “When a Doctor Needs a Doctor”

Doctors Make the… …. Worst Patients • Knowledge

Doctors Make the… …. Worst Patients • Knowledge • Delay in Diagnosis

Doctors Make the… …. Worst Patients • Knowledge • Delay in Diagnosis • History

Doctors Make the… …. Worst Patients • • Knowledge Delay in Diagnosis History VIP Syndrome

Doctors Make the… …. Worst Patients • • • Knowledge Delay in Diagnosis History VIP Syndrome Anxiety

Caring for Physician Patients JAMA 1998 “Caring for Physicians and Their Families”

Caring for Physician Patients • Clarify patient-physician relationship early

Caring for Physician Patients • Clarify patient-physician relationship early • Thorough history and physical

Caring for Physician Patients • Clarify patient-physician relationship early • Thorough history and physical • Balance objectivity and empathy

Caring for Physician Patients • • Clarify patient-physician relationship early Thorough history and physical Balance objectivity and empathy Privacy and confidentiality

Caring for Physician Patients • • • Clarify patient-physician relationship early Thorough history and physical Balance objectivity and empathy Privacy and confidentiality Acknowledge anxiety

Caring for Physician Patients • • • Clarify patient-physician relationship early Thorough history and physical Balance objectivity and empathy Privacy and confidentiality Acknowledge anxiety Time

Risks for Physicians as Patients • • Drug and alcohol abuse Depression Marital instability Suicide JAMA 2003 “Confronting Depression and Suicide in Physicians”

The Physician as Patient • Surviving • Healing • Thriving