When Doctors Perform As Patients

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In the last few years, stories of doctors-turned-patients have thoroughly saturated the medical community and some parts of public life. Think of Paul Kalanithi’s bestselling memoir When Breath Becomes Air, about a neurosurgeon’s experiences after a fatal cancer diagnosis. In the same vein, see Rana Awdish In Shock: From Doctor to Patient, about a resident’s sudden illness, or Robert Klitzman’s When Doctors Become Patients, which is based on the author’s interviews with 70+ ailing physicians. These stories typically follow the same formula: the provider falls ill, experiences an identity crisis, and then is so transformed by the experience of illness that they become a more compassionate caregiver and human being.

Sometimes, this catharsis is described as a truly transcendent experience. For instance, a doctor at the Medical College of Wisconsin recently described the “out-of-body experience” of hearing his doctor speak in the same clinical voice he used with his own patients—an experience that “took his level of empathy to a new high.” A colleague of his describes how a chronic illness renewed her dedication to patients: “I feel a deep calling that is almost religious. This is my exact purpose in life…I am here to help.” Another physician relates, “I know what suffering feels like. I know what challenging situations feel like. Having that firsthand experience, . . . I have cultivated a deeper sense of empathy for others.”

This storyline of the wounded, awakened healer is well-established. In Greek mythology, the centaur Chiron was wounded by Heracles’s bow, and his lifelong pain led him to many insights about caring and the healing arts. When Esculapius founded Western medicine, he applied many of Chiron’s insights. More recently, the early 20th-century psychotherapist Carl Jung wrote, “Only the wounded physician heals.” Such was the premise of the famous neurologist Oliver Sacks’s 1984 memoir, A Leg to Stand On, written after a near-fatal leg injury. A few years after Sacks’s best-selling book, the self-described egoist Ed Rosenbaum published his own memoir, A Taste of My Own Medicine, about coming around to his patients following a cancer diagnosis. This book was later adapted for screen (The Doctor) starring William Hurt.

“Medical authority is compounded by classism, racism, sexism, ableism, cissism—all of the ‘isms.’ Does being “on the other side of the stethoscope” reverse all of these forms of bias?”

The trope of the wounded, awakened healer may be moving, but it minimizes the fact that many forms of prejudice underwrite clinical practices. Medical authority is compounded by classism, racism, sexism, ableism, cissism—all of the “isms.” Does being “on the other side of the stethoscope” reverse all of these forms of bias?

Physician-turned-patient narratives work hard to convey that the provider finally “gets it.” For instance, they include a lot of sensory details of the clinical environment—the coldness of the room, the transparency of the paper gowns, and the offensive smell of sterilizers. They also recount varied experiences of humility, such as being called Mr. or Ms. instead of Dr.; being patronized by providers with far less expertise; or experiencing long waits before being seen. With these details, readers are expected to believe that doctors have been fully and truly humbled—that after all these years, they are one of “us.”

But a thin paper gown doesn’t begin to explain the vulnerability of a female patient, whose lifelong pain has been dismissed by medical authorities as anxiety. Room temperature and disinfectants don’t begin to suggest the discomfort of a disabled woman, who is shamed for refusing a doctor’s recommendation to get her tubes tied. Long wait times do not compare to the scolding and looks of disdain received by the African American patient with Type 2 diabetes, who is far more likely to receive substandard treatment than her White peers with the condition.

Of course, physicians may experience such compacted injustices themselves when they are subjected to medical authority. If so, it does not appear that they are leveraging these experiences to better understand the robust power dynamics in the consulting room. What if, instead of writing about their newfound empathy, these physicians used the occasion of illness to explore some of the ideological barriers to empathy that exist within their profession? Their in-between-ness might enable insights that are not apparent to providers or patients alone.

There is one moment in Kalanithi’s memoir that suggests as much. Toward the end of the book, the neurosurgeon recalls a visit to the emergency room, where he is seen by a resident who treats him not as patient, but as “a problem: a box to be checked off.” At first, Kalanithi is perplexed; after all, the resident knows he is a doctor. He thinks back to med school, when a patient once explained her habit of wearing her most expensive pair of socks to the doctor’s office. “When she was seen in a patient’s gown and shoeless, the doctor would see the socks and know she was a person of substance, to be treated with respect.” Kalanithi writes, “Ah, there’s the problem—I was wearing hospital-issue socks, which I had been stealing for years!”

The passage is tongue-in-cheek, but it simultaneously reveals a very real crisis in care: some patients are accorded more dignity than others. And as a result, they receive better care. In fact, staff at certain hospitals go out of their way to identify affluent and V.I.P. patients (for instance, giving them blankets of a different color) so that other staff members know to take special care of these persons. Perhaps Kalanithi, ten years into his practice, had participated in such practices. In which case, his memory-triggering patient experience could provide an ideal occasion for thinking about ways in which some lives are valued while others are not.

Doctor’s illness stories, such as Kalanithi’s memoir, are important. They undermine the ableist culture that cloaks the practice of medicine, and they demystify the imposing figure of the doctor. But they ought to do more than narrate doctors’ moral developments and discuss empathy in too-abstract terms. They ought to provoke questions about the politics of medicine: Who receives quality care and who doesn’t? What does it really mean to “do no harm?” And most importantly: how and when do medical authorities speak with the same voice as others who do harm?

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About Author

Audrey Farley is the Editor in Chief of Pens and Needles. She recently earned a PhD in English from University of Maryland, College Park, where she studied contemporary American fiction, popular culture, and the medical humanities. She has written for various peer-reviewed journals in the literary fields, as well as outlets such as Public Books, ASAP/J, and Insulin Nation. She lives with chronic migraine and is the parent of a child with Type 1 diabetes. Follow her on Twitter @AudreyCFarley.

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