When Doctors Get Sick

WHEN DOCTORS GET SICK HOWARD M. SPIRO* Over the past few years, a colleague and I have been collecting the stories of doctors who have been sick [I]. Curiously, such tales are not easy to find. Doctors write case histories willingly enough and report research enthusiastically, but they rarely write stories about their patients and they almost never write about their own illnesses. That is too bad, for what doctors learn when they are sick can help us all to improve the care we give and to think more resolutely about how we live as doctors. What sick doctors have to say about the treatment they received may help to improve medical care, but what they do not say may make us wonder about how we train people to give clinical care. These stories have been of such interest to me that I will review some of them. I have looked in the stories for clues to how I may, somehow, come to terms with illness and disability, retirement, and impending death. Medicine has become a young person's game (the very metaphor requires youth), particularly as advances in cell biology transform clinical understanding. Yet I share the idea ofmany psychiatrists and poets, that in all of us the fear ofdeath is suppressed so that we can take somejoy in our world. Doctors, I suspect, have that fear stronger than most and repress it best, thanks to their training. But it is always there, and illness frees it faster for the doctor than for others. Many may disagree with this notion, but listen to a regent of the American College of Physicians: "I have lived most of my life with a certainty that 'a big illness' was waiting for me----- I was in a better position to deal with it if I was a physician. So I became an internist" [I]. Physicians WL· Write Doctors who have written about themselves on their own initiative are usually more literate than their fellows and often more imaginative, but This paper was presented as the first Zachary M. Kilpatrick Lecture at the Medical CoUege of Georgia, Augusta, Georgia, September 26, 1986. ?Program for Humanities in Medicine, Yale University School of Medicine, 333 Cedar Street, Box 3333, New Haven, Connecticut 06510.© 1987 by The University of Chicago. AU rights reserved. 0031-5982/88/3101-0553$01.00 Perspectives in Biology and Medicine, 31, 1 ¦ Autumn 1987 | 117 they are rare in the mainstream of medicine. For most physicians, illness and disease have become such everyday experiences that there seems no reason to write up anything but their science. The anecdote is meaningless , we are taught, and the personal story in newspaper or magazine has until recently been seen as eccentric or self-seeking. Our medical language helps to keep doctors from writing about sick people. Technical jargon much of the time, medical writing uses abbreviation and clichés to convey "facts," not feelings. Case reports describe diseases, not people. "A 60-year-old WDAVN white male" hides any hint of character or accomplishment. From the patient we extract the case. The sonogram shows the flow of blood but not the real heart. There may be a more practical reason: practicing physicians usually feel that they need to maintain an aura of perfection. Reliability and availability are key. A middle-aged pediatrician in a small Connecticut town who developed Parkinsonism was sure that his mind andjudgment were as good as ever, but he feared that his patients might leave a doctor "less than perfect." The powerful chairman of an academic internal medicine department knew that having a myeloma took away his future: he could not be counted on to be there [2]. "My previous inborn sense of immortality [was] totally destroyed . . . the school leaders . . . also discounted my future. ... I had no future, the present was in disarray, and even my professional past, which had been the background for the work I was doing and was about to do more of, was made to look wasted." To play the role of omnipotent healer, the physician must seem immune to disease. Yet Ulness can give doctors who will take it time for reflection. George Pickering recalled how...