The Worst Patients Ever

Doctors make the worst patients imaginable.

After several months of being told I should start myself on Metformin for my Polycystic Ovary Syndrome (PCOS), I finally caved and took my first pill this morning.

To be fair to me, I did try to take Metformin the first time my OB-Gyn friend (take note that this was not part of a formal consult) told me it would be a good idea, but I had the most horrendous bout of GI upset after only taking 1 pill... and I swore off the drug completely, advice from my Endocrinology and other OB-Gyn friends notwithstanding. All this despite the fact that I already knew I was a textbook case of PCOS and had the ultrasound to prove it. You'd also think that since we have a very strong history of diabetes and high cholesterol in my family, I would be more cautious. Not so. As a matter o fact, I also threw the advice about diet modification, exercise, and weight loss out the window.

When doctors get sick, it's not a matter of not knowing any better. I think it's part of our medical education to live in some form of denial when it comes to our own bodies.

Take, for example, all the doctors who continue to smoke incessantly despite the very strong evidence that smoking can lead to lung cancer, bladder cancer, and other malignancies, chronic obstructive lung disease, heart disease, and a host of other medical problems. We've all taken the same classes, read the same books, seen the direct evidence of how smoking wreaks havoc on the human body. We all advice our patients with hypertension and heart disease to quit smoking cold turkey because we all know it's sound medicine.

But my smoker doctor friends keep on smoking anyway.

There are many instances when illnesses among medical residents are picked up relatively late simply because they either ignore their symptoms or decide they know what's wrong with them and treat themselves.

There's an interesting article here about a study done in Australia about doctors' health seeking behavior. Participants in the study believed it was acceptable to self-treat acute conditions. A good proportion of the respondents believed doctors are also reluctant to attend another doctor when he is ill. In another article here from the British Medical Journal (BMJ), a review of existing evidence suggests that doctors are less likely than other professions to take time off work due to ill health. The alternative is often self-medication or consultation with colleagues about their illness.

The BMJ article goes on to point out that, "a culture of ‘not being ill’ is seen as inherent within the medical profession." Simply put, many doctors feel that they are ‘not allowed to be ill’, because it is seen as a form of weakness. Heavy workloads and staff shortages mean that for many doctors, it is virtually impossible to take time off for ill health. In our world, if you don't go to work, your already overworked colleagues must take up the slack or else your patients suffer. So you treat yourself and keep on working - until you get well or get worse, whichever comes first.

Ironically, this culture of ‘maintaining a stiff upper lip’ ultimately impacts on patient care - not only are they treated by a doctor who is less than 100%, but doctors with communicable diseases also run the risk of passing it on to their patients.

I've had at least two batchmates who nursed fevers and headaches for at least a week treating themselves with nothing but paracetamol who eventually were diagnosed to have typhoid fever. One of them was eventually admitted for a few days for IV antibiotics. A couple of years ago, an entire batch of neurosurgical residents were noted to be losing weight - a rather normal occurrence for toxic would-be surgical specialists in training. After one of them ended up being admitted for shortness of breath because of having fluid in his lungs, everyone else finally got themselves examined. All of them turned out to have tuberculosis and needed to be treated for 6 months.

But the biggest irony of all is that many of us, especially the junior doctors, are unaware how we would access support for ill health. My resident friends who had to be admitted had to pay for their expenses out of pocket (or their parents' pockets). The expense had a considerable impact on their finances, given their meager monthly salary, slightly discounted bills, PhilHealth, and waived professional fees from our attendings notwithstanding. Medicines are still purchased at full price, and we don't have any drug samples to cover our full treatment. I did an informal survey among my co-residents, and it turns out that none of us have medical insurance.

Is it any wonder why we are in such denial when it is our turn to get sick?