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  • Caution Ahead—Physician Parent
  • David Alfandre

The benefits of being a practicing physician were immediately obvious to me when peripheral members of my family or acquaintances had medical questions or became ill. Friends and family clearly appreciated when I shared my medical knowledge as an internist, or helped them navigate the complicated institutional structure of hospitals and clinics, or simply provided context and background information about their illnesses. I was able to be helpful even if their question didn't involve my specific area of medical expertise because I could piece together how to be helpful simply by providing a framework for thinking about their problem. What did they understand about their illness? What had their doctor told them already? Did they understand the range of options available to them? Oftentimes, these discussions helped them formulate and clarify the questions they needed to ask their physician.

These discussions offered me the opportunity to be a guide or a medical translator, and a source of knowledgeable support. I enjoyed this because I love being a doctor. I love medicine and its lofty social mission. I am constantly stimulated by its ever expanding knowledge base. I am grateful for the privilege of caring for others. The benefits of my profession were obvious to me. But until my 2 ½ year old son became critically ill, I had never experienced my medical training as a liability.

It began as a fever that wouldn't go away. On its fourth day when we took our son to his pediatrician, his oxygen saturation was measured at 88% and my heart sank—at least, the part of my heart that belongs to medicine. From my medical training, 88 was a concerning number, representing a slide down the steep portion of the oxyhemoglobin dissociation curve, which indicated an appreciable lack of oxygenated blood available to his tissues. When our pediatrician recommended transferring him to the ER for further evaluation, we traveled back across town to the hospital where she had admission privileges, and where I happened to practice as well.

Whether it was because the ER wasn't very busy, or because I had left my hospital ID visible, or because he was so sick, our son was seen and evaluated by the ER fellow soon after our arrival. My wife was 36 weeks pregnant so I went with our son as he sat still for the x–ray. Passing the x–ray technician's computer on the way out of the room, I saw a little digitized body with an entirely opacified right lung. Rather than consider the opacified lung as initial objective evidence of serious illness, my first impulse was to assume that it wasn't my son's. When we got back to the ED, the fellow informed us that our son had a significant pneumonia and asked if I wanted to see the x–ray. "It's impressive," he said with what seemed like a mixture of interest and excitement. We stood together as colleagues examining the image on the computer screen, as the fellow commented on the extensive air–space disease and pleural effusion.

I hadn't consciously realized it then, but it felt like other health care professionals were more likely to regard me as a physician first, rather than as a parent. The fellow who saw my hospital ID excitedly shared the radiographic details of my son's concerning x–ray findings, like physicians sometimes do when presenting during an interesting case during conference. This left me with my first feelings of ambivalence. It wasn't just the health care professionals who were treating me as a physician first; it was me too. I wanted to use (and maybe even felt comforted) by all my accumulated medical knowledge in order to help my son, but in my current situation, I couldn't process all of the complex clinical information. [End Page 12]

Over the next few hours after we were brought upstairs, a parade of specialists visited the hospital room and my fear for my son's declining health left me less equipped to use my skills as a physician. When the pulmonologist told me about my son's pulmonary effusion...


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pp. 12-14
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