Physician, Heal Thyself

September 1, 2009

At 25, I sat by the phone at the appointed hour waiting to hear from a neurologist. He carried bad news, but thought that a quick call would be a fine substitute for the intimacy of a personal visit. “You have MS.” Diagnose and adios. Nothing more to say. Bye. His cold detachment launched my maiden voyage into illness; it will stay with me for all my days.

Stigma knows many forms and can become just as debilitating as a condition itself. It chips away at a person’s self-esteem and adds heft to the baggage on our backs, weight to the load we must carry.

When we find ourselves on the receiving end of stone coldness or worse, and it comes from our trusted physicians, we know we have lost a valued ally. Take mental illness. “Before my illness, I used to view patients with depression with bewilderment and disdain,” Dr. Paul Konowitz wrote in a letter to the editor published in The Boston Globe. Konowitz, an ear, nose, and throat specialist who teaches at Harvard Medical School, underwent an effective though involuntary form of attitude therapy. He became sick with a rare, life-threatening, chronic autoimmune disease. And the shoe switched feet.

“I used to walk into the examining room with my bias. I would check out the chart before I saw a patient. If I noted the use of an antidepressant, I would wonder if the problem was real or if the patient was crazy,” Konowitz admits. “Then my depression became really bad. I realized an antidepressant is like blood pressure medication, a legitimate drug. That was a big change for me.”

That judgmental edge is not about mental illness alone. Konowitz says that chronic pain is another area where doctors can be suspicious. But why do so many physicians bring unreasonable doubt to the bedside? “When you cannot measure the problem, if there is no blood test, understanding is hard to come by,” he says.

Perhaps a physician’s closed mind relates to simple frustration at a human being’s inability to help patients, not just with those with mental illnesses and chronic pain, but with the myriad of other medical mysteries. American medicine is the best in the world. Just ask an American doctor. But in the practice of medicine, there is much that is not known or fully understood. That may be a tough pill for a lot of doctors to swallow.

It is not just the lay public that bears the brunt of physician impatience with physical limitations they do not always understand. “Physicians are indirectly taught to ‘man up’ and keep silent about their own issues,” Konowitz wrote. The doctor must stand taller than the rest.

The Quack Frog, one of Aesop’s fables, teaches the well-known moral: “Physician, heal thyself.” The message might as well have been, “Exist as one with perfection.” Aesop must have been referring to a surgeon. After all, who would go to a dermatologist with warts? Maybe the problem lies with us. Perhaps we insist that something is wrong with a doctor who is carting around human problems.

Dr. Paige Church has seen this from both sides. She has congenital spina bifida, and as a neonatologist in Toronto, she deals with many young children with similar, serious problems. She, too, believes physicians are threatened by illnesses in their own ranks.

“There is a line differentiating the physician and patient. It is not acceptable to share one’s own weakness,” she writes in an unpublished essay. “I maintained my silence [about my own illness] to avoid being perceived as weak or less able by colleagues. I am not. I have come to recognize the stigma of these conditions and of a physician openly having them.”

The doctor double standard can be powerful. My father, a doctor himself, believed many individuals became doctors to beat their own mortality. It seems to me they are too well-educated to possibly believe that is a battle they can win.

We tell ourselves that times have changed in America. No longer do we extend a hand to our physicians so they may laboriously climb onto those lofty pedestals where, too often, we still believe they should stand. It is okay that our lawyers and accountants be jerks, but our doctors? No. They must be held to a higher standard.

We have not decided what we want our doctors to be. I am not looking for a friend. I just want good advice. I scoff at the idea of doctor’s “orders.” If we do not like our physicians, never mind taking offense at whatever biases come our way, we should go shopping for replacements.

We demonstrate more care shopping around for cars and consumer items. Maybe we need to decide what we are looking for and find it. The rest will take care of itself.

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