I can still vividly remember the first doctor-patient I ever looked after. He was a retired GP and perhaps slightly unusually for a doctor was an extremely laid back personality. I was a brand new FY1 still scared of my own shadow. I recall physically shaking when I had to cannulate him for the CT that detected his widespread disseminated lung malignancy. He was so calm and collected about the whole situation, refused any Oncology intervention and returned home with his wife for palliative care.
I think most doctors have that ‘heart-sink’ feeling when they discover one of their patients is also medically trained. I know I do. Is that because we feel our knowledge or skills are under the microscope? Are we more scared of missing something vital? Perhaps we already have a professional relationship with that particular individual? Maybe we want to ‘look after of our own’ to the very best of our abilities and put ourselves under more pressure to achieve this?
With all this in mind I had very mixed feelings when last summer I became suddenly seriously unwell with an advanced, rare and aggressive form of sarcoma. At first I dealt with the situation by almost thinking of myself as my own patient. I wanted to see and interpret all investigation results for myself. I wanted to be fully in control of all clinical management decisions. It was almost as though I was looking in on my life from the outside. By keeping everything on a medical level initially I was probably subconsciously protecting myself psychologically from the horrendous situation I was facing.
As time went by and I endured the horrors of intensive palliative chemotherapy I managed to relinquish some control. This was because on occasion I was just too ill to be capable of clinical decision making for myself. When this happened I remember feeling weak and pathetic. I am not an Oncologist, although soon after diagnosis I had researched my condition thoroughly, but I had to rely on my Oncologist’s knowledge and skills, and it took a long time for me build this trust in him.
I feel that perhaps sometimes my behaviour could be compared to that of a teenager. If my doctors have suggested one possible path, I have wanted to pursue a different route. Although I know he won’t, I have a strange fear that my Consultant will somehow judge my own medical prowess if I ask a stupid question. I try not to but I always end up thinking about my care with my Physician head on. I like to ponder logically about all the likely outcomes of a particular decision or action and always contemplate whether doing nothing would be the best option for me too. This has changed my cancer journey to a bespoke one which suits me better. For example I have not had routine restaging scans since stopping chemotherapy as I feel that they would not change my management and watching my cancer deteriorate on scans could have a devastating psychological impact on me. Instead I have decided that I will only have a scan if I develop symptoms that my Oncologist feels he can help with his poisons. This desire to drive my own care has been instrumental in me achieving my wishes.
I have on occasion been a ‘difficult’ patient to look after in my eyes. I would not want to look after me! Sometimes I have been argumentative and quite assertive, although never rude. Because of this I have found myself having to apologise for being a nightmare several times. Luckily my Oncologist has a thick skin! I have also formally complained about my care twice when things have been worryingly unsafe. This is not because I have a personal vendetta against anyone who has cared for me, but because I have insight into patient safety from an unusual perspective and that hopefully by complaining standards of care can improve.
It is so difficult when a doctor turns into a patient. We have baseline knowledge and skills, professional contacts, specific ideas and expectations that perhaps ‘lay’ patients do not have and these need to be considered when caring for us. All in all I feel being a doctor makes being the patient slightly easier for me, but probably makes the job for my medical team more challenging and I always have to remember this when interacting with health services.