Self-delusion and self-care

Issue: BCMJ, vol. 50, No. 8, October 2008, Page 433 Editorials

It started in the night and I wasn’t even naked. My generalized abdominal pain gradually worsened but was only a mild ache by the morning. I vomited after eating my lunch and thought I must have the flu that my colleague had the previous week. 

That night the pain progressed and localized to my right lower quadrant. I found some old oxycocet tablets in my cupboard and after quaffing a couple had a decent night’s sleep. “So this is what mesenteric adenitis must feel like,” I thought to myself. 

Off to the hospital I went to do rounds, but interestingly I had to lift my right leg in and out of my car due to the pain. I also found myself walking in a kind of Quasimodo-like position. I thought, “Wow, this mesenteric adenitis can really be a bitch.” 

Later that morning while seeing patients in the office, my concerned colleagues wanted to know why I was walking like I had suffered a stroke. I explained my insightful diagnosis of viral-related abdominal lymph node pain, at which point they told me I was an idiot and to go get myself checked out. 

To prove them wrong I gingerly lifted my copy of Surgical Diagnosis and Treatment off the shelf and began to read the symptoms of appendicitis to my clearly misguided colleagues. To paraphrase it went something like this, “The pain is often preceded by vomiting… eventually moving to the right lower quadrant: forcing the patient to walk like Quasimodo… often the patient will deny there is a problem, particularly if he is in the medical profession.” So, okay, I was going to need more evidence to get them off my back. 

I thought that an abdominal CT would give the most information and allow me to miss the least amount of time from the office. I dialed up the CT radiologist and told him I had a 43-year-old man in the office who needed a CT to confirm he didn’t have appendicitis. “What’s his name?” he asked me. 

After seeing a few more patients and telling my staff I would be back soon in a smug voice loud enough for my colleagues to hear, I headed off for my scan. I had to drive with my torso contorted into a ball such that I looked like one of those thick glasses-wearing osteoporotic seniors with their faces pushed up against the steering wheel. 

I also remember letting loose an involuntary moan as I rolled up onto the table. The radiologist let me look at the scan and said, “Sometimes with CT it’s hard to make a diagnosis of appendicitis, but your swollen, inflamed angry-looking appendix helped me a little.” “But how do the mesenteric lymph nodes look?” I asked hopefully. The look on the radiologist’s face convinced me to contact the on-call surgeon. 

I related the relevant information to him, “I have a 43-year-old male idiot with clinical and now CT-supported appendicitis in the radiology department.”

“Send him over to ER, and what’s his name?” he requested. Why is everyone so preoccupied with this name thing? 

It was now about noon so I figured that as my surgery wouldn’t be done until the late afternoon or early evening and as my pain was lessening that I should go back to the office and work until it was time for my operation. Apparently narcotics make you feel better and impair your judgment.

Within a few hours I had my ruptured appendix removed and after a few febrile days in the hospital on IV antibiotics I started to recover. 

The moral of this editorial is not the obvious one (that I am an idiot), but that as physicians we don’t take very good care of ourselves, or for that matter each other. We give patients advice about stress management, lifestyle changes, counseling, addiction, mental health, and more, but then ignore our own advice. I wonder how many of you even have your own family physician. 

I think this lack of care often extends to our colleagues. How many of us take the time to ask about the sadness in their eyes, their new irritability, or their obvious lack of joy? We are all very busy, but if we don’t look out for each other, who will?
Sure it takes some time, but wouldn’t you like that effort made if the situation was reversed? Sometimes all it takes is a kind word or an act of support to make all the difference. However, not all problems are solved easily and I would recommend accessing the Phys­ician Health Support Program (604 742-0747, 800 663-6729, 

Encouraging a struggling colleague to make the call, while a simple act, may be one of the most important. Who knows, making your own call may even save a life—yours.  


David R. Richardson, MD. Self-delusion and self-care. BCMJ, Vol. 50, No. 8, October, 2008, Page(s) 433 - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply