It must be great, people say to my wife, to have a doctor as a husband. They imagine a doctor spouse as an infinite source of medical information, a calm presence in the face of a family medical crisis or someone with an ‘always on’ bedside manner. Take it from me – its not all its cracked up to be.
Although I like to see myself as reasonably competent, rational doctor, when I faced with a sick family member I am, as my wife reminds me ‘useless’. I tend to either worry excessively (absorbing the patient / family’s anxiety as my own), or adopt a protective shield of denial or indifference – not taking the medical problem as seriously as I should. There is no middle ground when caring for those you love.
Of course when I imagine myself as a patient, I see myself as one who might be knowledgeable, rational, assertive and at all times an active participant in any treatment decisions made on my behalf. An equal partner in care.
The reality is altogether different. Whilst on the receiving end of medical care (or when one of my family is) I usually find myself adopting a much more passive role in care and deferring to the treating doctor to advise on the important decisions.
This is (I think) because I understand that good medical care consist of 3 key elements; information, knowledge and objectivity.
Having spent a few years in medical school and having access to the internet means I can have access (just as my patients do) to unlimited amounts of information. I can formulate lists of differential diagnoses, treatments and side effects with the help of Google, Wikipedia or Medscape. But that information is of limited use without the knowledge of how to apply it.
Knowledge, and wisdom to apply it, can only be acquired through experience. In the case of any specialist this is learned through exposure to thousands of patients in training and throughout a career. It comes through learning how to spot patterns and clusters of symptoms, learning that many of our patients do not conform to the descriptions in textbooks (or online articles) and learning how to deal with uncertainty. It is learned through the feedback loop of the experience of getting things right, but also through the humbling awareness that we sometimes get it wrong (all the while accepting responsibility for either of these outcomes).
But even knowledge isn’t enough. Good doctoring demands a degree of emotional remove from our patients. While caring for loved ones (or ourselves), the calm objectivity that emotional detachment affords goes straight out the window. To care well for our patients, we sometimes have to care less.
In an era where paternalism is sometimes frowned upon, sometimes its nice (and better) just to be looked after.
Illustration by Alison Seiffer from http://educationnext.org/an-appeal-to-authority/