It’s a well-known fact about the practice of medicine that things are more likely to go awry when you are caring for someone you know, particularly a colleague. The practice of medicine is challenging enough, but throw in a little familiarity and things can get really tricky. Most of us have an experience or two that cements this opinion, although, thank goodness, I have never had to look after a cardiologist with chest pain, a surgeon with appendicitis, or a psychiatrist with depression. For those physicians who have, I take my hat off to you.
Many years ago, a classmate faced the difficult situation of caring for a member of my family. We knew each other well, but we were not friends. He was on call the night my relative’s condition deteriorated, and despite all his efforts little could be done to help. He was in and out of the ICU constantly, eventually even going back to the OR with the patient. He continued to try different things to achieve some stability in my relative’s condition, but to no avail. I was oblivious at the time to how difficult it must have been for him to deliver bad news to a peer and express the failure of all his efforts and expertise. We both had so much faith in the ability of advanced medicine to cure.
Most of us will be in a similar position at one time or another—caring for colleagues, their spouses, or their family members. Colleagues are the most difficult. It starts with gathering the history. The process of using everyday terms and explaining things in non-medical language just feels wrong and, at times, awkward. You find yourself getting tied up verbally, changing expressions and correcting yourself after using lay vocabulary, knowing it is completely unnecessary. Of course, you then ask yourself if you are assuming too much understanding and comprehension. You don’t want to speak as if they have limited knowledge, but ingrained habits are hard to put aside. Naturally there is varying familiarity with different aspects of medicine depending on a physician’s training and specialty. Trying to avoid any impression of condescension, I am sure there are times when I have left out information and questions have remained unasked. Giving outstanding service, in addition to an accurate and compete diagnosis, is our critical goal.
I’ve learned that when caring for a colleague, that person is a patient first and foremost. As we know, the actual process of care can be convoluted and as caregivers we can encounter many roadblocks. Sometimes our systems of care don’t quite work as we expect them to. Because such concerns are routinely discussed with fellow physicians, they can also slip into conversations with physicians who are our patients. I once received a passionate dissertation from my mother’s physician, while she was awaiting transfer to a tertiary centre, about the paucity of services available to provide for her care. Her physician was speaking to me as a colleague, not as a worried daughter. I thought I had put my professional self aside but perhaps I gave him the wrong impression. Hearing his concerns about the quality of care my mother would receive from the health care system I felt an added burden, worrying whether she would get the care she needed.
While physicians want to talk directly with those caring for their relatives, we need to remember that it is hard for patients and families to absorb all the medical information they receive, particularly when an illness is critical or unexpected. The questions patients and their family members ask us are pointed and usually strike at the heart of the matter. It’s great when you have all the answers, but hard to say “I don’t know”—and even harder to say it to a colleague.
I have great respect for the physicians who find themselves in the position of needing to provide care for their colleagues and family members. It isn’t easy. Expectations are high and we all want to give our very best.
I sometimes do prefer strangers, actually.