When the Physician Is a Patient
As the chief hematologist for the Veterans Affairs Medical Center in Washington, D.C., Geraldine Schechter has always tried to be an empathetic physician. But it took becoming a patient with a life-threatening illness for her to see medicine in a different light.
Dr. Schechter spent about two months off and on in the hospital recovering from large granular cell leukemia, a nonagressive cancer that made her white blood cells disappear. During her illness, Dr. Schechter contracted an abdominal infection that caused a raging fever. Without white blood cells, her body could not fight the infection. Most of the time, she says, she never really believed she would die. But there were brief moments of fear when she thought it might be possible.
For the 59-year-old physician, the experience of being a very sick patient was educational and bizarre. Leukemia was one of her specialties and she was being cared for by physicians she had trained. Like most physicians who become patients, she knew a little too much about what was happening to her body.
An Eye-Opening Experience
Dr. Schechter, now fully recovered and back at work, learned a lot from her experience. She gained a new respect for the important role nurses play in caring for patients. "They were there all the time."
She also was struck that nobody overseeing her care asked about what kinds of interventions she would want in case she reached a critical juncture in her treatment. "They all acted like I would want everything to the end." Dr. Schechter says in fact she did. But she was surprised that physicians never asked her opinion or checked to see whether she had a health care proxy. "My doctors read me very well. . . but they did the wrong thing. They should have asked me."
One of her most unsettling moments was when a group of physicians and residents making rounds told her in a rather blunt way that she needed surgery because the antibiotics were failing. She knew that surgery was risky and she might not survive. "They hadn't prepared me for that and someone said I looked like a frightened animal. . .It was like being told that you didn't have hope." Dr. Schechter says it made her think about the manner in which physicians tell patients about their treatment options.
An Increased Sensitivity
The experience as a patient has made her a more sensitive physician. "I just identify more with what patients are thinking," she says. Her biggest concern now is whether patients are getting enough pain medication. Although she wasn't in a lot of pain during her illness, she is adamant about ensuring that patients not suffer needlessly. She routinely checks to make sure orders allow patients to control their own pain medication rather than having to call for the nurse. She also tends to spend more time with her patients and talk to them about their condition and how they are feeling. Although it slows her down -- a practice in conflict with the pressures of managed care -- it means a lot to patients.
Talking to patients about end-of-life issues has never been easy for Dr. Schechter: "When I was trained, we didn't talk to people about death and dying." She says that physicians are fairly criticized for how they deal with death and dying, but that patients and families need to understand the tension they face daily. Although she tries to talk to patients routinely about advance care planning, she has a hard time juggling often conflicting roles. On the one hand, patients are looking to her for hope. "I am their advocate and I'm supposed to do my best for them," she says. At the same time, she is supposed to help patients come to terms with the prospect of dying.