Monday, January 20, 2014

The Doctor as Patient

The Doctor as Patient

   Arnold Relman has written a fascinating article in the February 6, 2014 edition of The New York Review of Books entitled "On Breaking One's Neck".  In it he recounts his experience with a near fatal accident which he suffered in June of 2013.  He talks about his experience in the modern medical system and his long and arduous rehabilitation efforts.  What is unique about his experience and his recounting of it is his perspective.  Arnold Relman is a 90 year old Professor Emeritus of Medicine and Social Medicine at Harvard Medical School and was the editor of The New England Journal of Medicine, the most prestigious of American medical literary journals, for fourteen years (1977-1991).   His perspective is unique.  He has reviewed his own medical record and had many conversations with his treating physicians, many of whom were friends and colleagues.

     He relates problems common to all critically ill patients - the fear, apprehension and physical pain.  He includes many details of his particular injury and care.  He notes that his family found him "more affectionate than usual"; his reasoning for this is that he needed them so much.  He relates how his care changed as he moved from the acute care setting to a rehabilitation setting.  He laments that he was not talked to very much, and that there were almost no references in his electronic medical record (which he terms "repetitious boilerplate language and lab data") to his mood or "state of mind".   He noted that as his physical capacities slowly returned he was "sobered by the realization of the fragility of my existence and my limited future."

     As a keen observer of the practice of medicine for three quarters of a century, he has some incisive further commentary.   After all of this time, he notes the critical role of the bedside nurse:  "I had never before understood how much good nursing care contributes to patients' saety and comfort, especially when they are very sick or disabled.  This is a lesson all physicians and hospital administrators should learn."

     He summarizes the enormous cost of his care and his good fortune of still being covered by the faculty health care plan, limiting his actual personal financial burden.   He then opines: "Is it justified to spend hundreds of thousands of dollars to extend a nonagenarian's life a little longer?"  He realizes that his opinion would be extremely biased by his current predicament and never answers the question, but it is compelling that he would even bring that up.

     Finally he ponders why he lived through this when by all rights he shouldn't have:  "There was something else that helped to sustain me.  I wanted to stay around as long as possible to see what was going to happen to my family, to the country, and to the health system I was studying so closely."

       I can relate to Dr. Relman's article all too well, having endured a life threatening illness myself seven years ago.  I would echo all of his sentiments, including the tremendously discomforting experience of confronting your own mortality.  I can also heartily agree with the sustenance one gains during trying times by the support and love of family.  The one thing that I would add to Dr. Relman's article that was important for me was prayer.  I never understood the comfort of being prayed for, but  I definitely could feel the prayers being prayed on my behalf in a way that is really difficult to put into words.  I am certain that prayer contributed greatly to my recovery.  I would never wish a major illness on a colleague, but I think an experience like Dr. Relman's (and mine) does give a physician an appreciation for many things routinely taken for granted.  Thank you, Dr. Relman, for sharing your experience and insight.

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