As physicians, we never want to be on the other end of the stethoscope. Before I had to navigate healthcare myself, I believed that the system was fair and equitable. Maybe I was young and naïve.

 

Confronting health scares at home

 

But then it happened. Last year, my father—a retired physician himself and an actual Ironman—got sick. It started with leg pain and swelling after a long run. Probably just a strain. Maybe a muscle tear. Nothing serious. But when the swelling got worse, we all made him go to the ER. He spent 12 hours there and spoke with a physician for only minutes of that time. 

I remember his voice so clearly on the phone on his way home: “I have a very large DVT and multiple bilateral pulmonary emboli.” He was discharged with a 2-week script for an anticoagulant and told he’d have a referral to the thrombosis clinic as an outpatient. 

 

Physicians in the family

 

As a “physician family” (my father, my sister, and I are all physicians), we immediately assumed the worst—he must have metastatic cancer. I instantly picked up the phone and got him an appointment closer to me to have a CT scan and follow-up. He saw several physicians and received fantastic, thorough care. Luckily, there was no cancer. But he never did receive that call for thrombosis follow-up. 

We couldn’t help but wonder: If he hadn't been a physician who knew better, would he have received the same care and instructions?

Would he have gone home, not knowing any better and stopped his anticoagulant 2 weeks later when the script ran out, assuming all was fine? Or was the care actually worse because he was a physician, and they assumed he would just know better?

 

Sometimes, we know more than we should

 

Then, a couple months ago, it happened again. This time, it was my mother. Another trip to the ER. This time, it was the worst-case scenario. Stage 3C ovarian cancer. As a close-knit family, to say we were blown away and devastated would be an understatement. 

It’s funny how grief can truly cloud any practical thought. But luckily, the care was excellent this time around. 

But still it’s difficult, because we’re usually the ones providing treatment. We constantly question: Should we pick up the phone? We don’t want to overreact or bother them. We read study after study and we know more than we’d like to most days. 

Sometimes, I wish I could approach health scares with the same blind optimism as most people who aren’t in the field.

In both instances, I struggled with the treating physician’s knowledge that we were physicians ourselves. Would it impact how much we were told because they would assume we already knew? Would it, in fact, get us access to better and quicker care, as it seemed to be in the case of my dad? Was it ethical to skip the line?

Many jobs have “insider perks”—shouldn’t we, as physicians, get these as well?

Or would it hinder our care by intimidating the provider, clouding their judgment?

 

Managing expectations

 

In navigating healthcare, physicians must consider opposing ideals and expectations.

Chen FM, Feudtner C, Rhodes LA, et al. Role conflicts of physicians and their family members: rules but no rulebook. West J Med. 2001;175(4):236–239.

We want to advocate best for our family members, and we want to be the ideal conscientious physician, but we also have to deal with both the expectations of family and those of other physicians. The system is flawed, and role conflicts abound. 

 

We need an ethical code to navigate the system, while acknowledging and not disregarding those flaws.

Then, there is the financial side of it all. Although I am Canadian myself, I am aware of the added barrier that patients, including physician-patients and their family members, face with regards to insurance and medical costs. 

Physicians working in the US understand the ins and outs of health insurance companies and how to navigate the financial aspect better than most of the public. It’s been proven that people with better health insurance coverage receive more appropriate and adequate care, and that uninsured individuals have poorer clinical outcomes.

Effects of Health Insurance on Health. Chapter 3. In: Institute of Medicine (US) Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. Washington, DC: National Academies Press (US); 2002.

In fact, in a study of PCPs’ perceptions of their patients’ insurance status, 88% of surveyed PCPs reported making a change in their clinical management decision based on whether the patient was privately insured, publicly insured, or uninsured.

Meyers DS, Mishori R, McCann J, et al. Primary care physicians’ perceptions of the effect of insurance status on clinical decision making. Ann Fam Med. 2006;4(5):399–402.

 

 

 

Overall, we’re at an advantage

 

Some studies show that being a physician-patient may actually be an advantage, leading to better clinical outcomes.

Morishita M, Iida J, Nishigori H. Doctors’ experience of becoming patients and its influence on their medical practice: a literature review. Explore (NY). 2020;16(3):145–151.

And yet, it’s never fun to be on the receiving side of healthcare. 

 

Being on this side has opened my eyes to the flaws in the system and posed many more questions than answers.

It has made me more aware of the way I communicate with my patients, and of the need to provide a comprehensive discussion regardless of their background. It has also made me a better advocate for my patients, because we all deserve a chance at the best possible outcome. But most of all, it has made me a better listener. I hear my patients’ frustration with the system, and now I finally understand.