Doctor Mode vs. Patient Mode

anDRea

G. Witlin, DO, PhD

Being a patient, especially a patient with a chronic, long term forever disease is daunting. To be real, it’s the most difficult job I’ve ever had. Most of us have experienced the other side of the spectrum, i.e., being the treating physician to a colleague or their family. We recall those experiences as challenging at best and fraught with conflicts of interest at worst. I was introduced to the concept of professional courtesy as a student. At the time, it meant no charge for office visits. Other “perks” followed - curbside consults during rounds, sneaking in for no-documentation visits after regular office hours, pilfering pharmaceutical samples rather than filling written prescriptions. Proper documentation as we know it today was purposefully absent. If there was no record, it didn’t happen. Illness and absence from our practices weren’t condoned. Correspondingly, on those rare occasions when we had “legitimate” appointments, we were uncomfortable in the waiting rooms and following the “rules” we laid out for our patients. No doubt, this blurring of the lines contributed to the false bravado and sense of invincibility that continues to haunt the medical profession to this day. We weren’t ever truly allowed to be “normal” patients, i.e., patients who hurt and cried and worried.

We constantly fought living in that vulnerable zone. Accordingly, my “bad” habits progressed.

During the early years, I tried to “assist” my colleague who was the rounding medical doc for our multispecialty group. At the time, I was hospitalized for a presumed DVT and my anticoagulation was being titrated with old fashioned unfractionated heparin. I asked my nurse to give me my PTT results throughout the night rather than to awaken my colleague. The following morning both the nurse and I got reprimanded. My colleague was especially displeased as he had slept on the couch so that his wife wouldn’t be disturbed. Unfortunately, patient mode wasn’t always so glib.

Years later as my personal medical issues multiplied and their respective complexity increased, I found myself trapped between those formative years of “doctor mode” behavior and the trepidation of sliding into “patient mode”. Instead of allowing myself to be a patient, it was as if I was on the outside looking in. I was once again, the young house staff on rounds reciting the “perfect” history hoping to curry favor with my senior resident or attending. I couldn’t help my years of training as I regurgitated my history as if I was writing an impeccable note or submitting a case report to a medical journal. At times, I presented a detailed written summary. In my mind, I imagined that it would be helpful and appreciated. Very occasionally, my docs showed appreciation for the meticulous, comprehensive summary. But more often than not, I was shunned or treated dismissively. My recitation was too perfect and thus many times not believed. At times, I purposely omitted a minor yet potentially awkward factoid. Correspondingly, I was rarely asked theoretically sensitive or embarrassing questions. This routine backfired when a senior faculty member/sub specialist instrumental for my ongoing care accused me of “reading the book” and parroting the history. I was beside myself. That particular physician refused to see me again because his time would be consumed by his pending, coveted academic promotion. To add insult to injury, none of his “junior” colleagues nor his peers would question his judgment and assessment. That experience set back my care and eventual correct diagnosis for seven years.

Those seven years were beyond arduous. Every now and then I would muster enough courage to venture back into patient mode. The “good” docs would validate some of my complaints and would encourage me to seek additional assistance that invariably ended without a therapy plan. Unfortunately, I also experienced intermittent unprofessional behavior. One subspecialist literally walked out midpoint of my scheduled office visit to go to her previously scheduled promotion and tenure interview. Another dispassionately referred to my treating subspecialists as “the quacks on the other side of the river”. (No, not one of the three rivers). The subspecialist who had initially diagnosed and treated me for 6 prior years equivocated and rescinded his diagnosis and treatment. At long last, my “doctor mode” finally prevailed and I ultimately found a new team that treated me with respect and allowed me to finally lapse into “patient mode”. My mind unwittingly reverts to my years of practice and how patients like myself disrupted schedules. So, I float back into doctor mode and attempt to figure things out and delay asking for help. The reality is that I’m now that troublesome patient that I loathed. I feel bad because I always manage to develop a disease flare or some other complication.

There are also occasions in patient mode when I totally lose control of my emotions. My husband jokes about trusting me to go to visits unaccompanied. A favorite story involves our trip to an out of the way, small, community hospital ER at 4:30AM. Neither of us was pleased with the journey that was necessitated by my clumsiness. I had missed the last step on route to investigating a phantom kitchen noise disturbing my sleep. He dropped me off curbside while he parked the car. I hobbled in on crutches in severe pain looking for anyone who could provide assistance. The first person I encountered was a rather large security guard not happy with me wandering behind the counter. He asked what I was doing…my response, “what the f*** do you think I’m here for”. He was ready to kick me out and bar me from receiving care when my husband arrived back on the scene and calmed everyone down.

Over the years, I’ve been a sieve for researching and scrutinizing my various medical issues. I’m always several steps ahead attempting to decipher some new meaning or therapy option. But there are also times when I drift back into patient mode and minimize or deny the inopportune symptoms of a pending flare. The learned panic and PTSD associated with patient mode become overwhelming.

In graduate school I was enamored by our lecture on the JAK/STAT pathway and how it was named for the two-headed Roman god, Janus. I often think about Janus, his two opposing heads, the god of beginnings, transitions and endings as I transition through my experience from doctor healer to vulnerable patient. The parable seemed fitting when I was recently prescribed a JAK inhibitor. Regrettably, my time in patient mode has multiplied exponentially. The transition is replete with emotional swings and vulnerability. It’s become infinitely more difficult to maintain the wall between the two and “appear” professional and pleasant at all times. Regrettably, I’ve recently observed several older physician friends and relatives who have completed that transition and no longer have a voice or ability to participate in their care. That is my worst fear.