Over the years, I have treated various medical professionals
from physicians to nurses to veterinarians to optometrists and to occasional
medical residents in training. Are these folks different from other
patients? Are there specific challenges
treating folks who have a deep knowledge of the medical profession? Are their unique risks to be wary of when
the patient is a medical professional?
First, it’s still a running joke in the profession that if a
medical student develops an ordinary symptom, then he worries that he has a horrible disease. This is because the
student’s experience in the hospital and the required reading are predominantly
devoted to serious illnesses. So, if the
student develops some constipation, for example, he may fear that he has a
bowel blockage, similar to one of his patients on the ward..
More experienced medical professionals may also bring above
average anxiety to the office visit.
Physicians, after all, are members of the human species. A pulmonologist who treats emphysema and lung
cancer – who now has a cough- may be more worried than his doctor will be.
There is also a phenomenon known as VIP Syndrome when
physician-patients paradoxically receive inferior care by virtue of their
professional status. The treating
physician in these instances, bends or ignores the usual practice protocols and
treats his colleague informally and inferiorly.
Follow this example.
Physician A runs into his own doctor, Physician B, in the Doctor’s
Lounge. Dr. A tells Dr. B that his
diverticulitis is acting up and requests that a course of antibiotics be called
in. Dr. B readily obliges.
This is an example of poor medical care. There was no review of the record, no
detailed medical history, no physical exam and no discussion of a wider
consideration of what the medical symptoms might mean. And, would this casual interchange in the
lounge even be entered into Dr. B’s record?
What if Dr. A actually had acute appendicitis and should be
in the operating room, not at work taking antibiotics? What if Dr. A developed a serious
complication from antibiotics that were not necessary in the first place? The irony is that it is medical professionals
who are vulnerable to ‘VIP’ care, which in this case should stand for Very
Inferior Performance.
Doctors should treat medical-patients in the same way that
all patients are treated. If the medical-patient
needs an intimate exam, for example, then it should be done.
No shortcuts. No
medical advice in the elevator. I’ve
had physicians from time to time call me or even text me for advice on their
condition. Usually, these are folks whom
I have not seen professionally for some time.
Without exception, I advise them to see me in the office so that we can
sort through the issues properly. Also without
exception, every one of these doctors readily complied because they know how
good medicine is practiced.
Do non-medical patients ever aim to short cut the
system? That query deserves its own blog
post!
Remember early in my training a wise doc told me "we doctors get the worse medical treatment cause they always jump the workup algorithms that a normal patient would go thrrough"
ReplyDeleteVIP can mean different things. For my MD students and MDs, it’s opening up my clinic early or later for them to work around their schedule, giving them my cell #, and pushing through their prior auth personally. I’m
ReplyDeleteMore strict on my MD patients because i know they will google something and go against medical advice so i go out of my way to explain why we we doing something. Also- if an MD asks for a blood test (like an iron level), for god sake, order the damn test.
After practicing medicine for more than five decades, I have come to the sad conclusion that there is no mutual respect and concern for a fellow physician if he/she needs medical attention. This has happened as these uncaring physicians have insulated themselves with office staff and are unapproachable. It is time the obligatory "Hippocratic Oath" should be called "Hypocritic Oath".
ReplyDeleteIn the early 90’s, an Ob/Gyn in my group was providing prenatal care to a nurse from another specialty area. She wanted only him to provide her care (he agreed to do that as a professional courtesy) accommodated her by seeing her after hours/workday. Somehow, the standard aneuploidy testing was never drawn and so no detailed ultrasound examination at the time. The baby was as born with trisomy 21, and litigation ensued. The intent was honorable, but this ‘special treatment’ resulted in a serious situation for the patient, her family, and the physician whose default was to be very careful and competent. I would have had him care for my own sister without giving it a second thought. This was a tragedy.
ReplyDeletePlease don’t ever make this mistake. If special treatment IS given, set VERY specific boundaries with your medical professional patients. This situation requires even MORE attention from the physician, not less, to keep YOU out of trouble. If the patient pushes back on this, just decline to provide the non-emergent) care for them…let them find someone else. Remember, just because someone is a colleague or a friend doesn’t mean they will not sue you if something goes very wrong.
Sad, but true.
this is why at my yearly exams i don't tell them i am a doctor. I get better care.
ReplyDeleteExactly. Treat me like a patient.
DeleteMaybe the good doctors are simply not aware of how patient's experience healthcare and it's systemic issues until they become patients themselves. As a physician and now caregiver of someone with a complex rare neurological disorder (less so with neuro-post COVID) that despite identifying early from family history, a condition that requires immunotherapy, patient was still labelled "functional neurological disorder" (aka hysteria, somatization, conversion disorder historically). Good luck getting that out of chart / cut and paste/ cut and paste. Something that no one can prove or disprove with no objective data for diagnosis. I am stunned by the VIP/ Very Inferior Practice, even when the diagnosis is figured out by fellow physician. Maybe it is "quit quitters" and physicians who don't want to dig deep for complex. Certainly able to dig deep into miss diagnosis and not change course even with evidence of biological basis. But on the positive with hard work, have found some really outstanding caring compassionate brilliant physicians. Maybe it's the brilliant!
ReplyDeleteHeart breaking. I remember a relative who was given a month’s worth of a drug for dementia even though he was having occasional forgetfulness but overall, just another chess champion editing a monthly cultural publication. It was impossible to get that out, even though he was only on it for 2 weeks. Dementia, that’s all. Just awful; his bad luck for being a doctor’s father.
ReplyDelete