When a doctor treats himself, he has a fool for a patient

September 5, 2008

We preach to our patients the importance of seeking medical care for their health issues. We as doctors are no different. We are not immortal, and when sick, we may not exercise the best judgment.

In medical school, the old adage was "Don't treat friends or family." I would add to that "Don't treat yourself." Errors in judgment can lead to potentially disastrous results. A few firsthand experiences have opened my eyes to this problem.

Several years ago, having been in practice for a while, I developed overwhelming fatigue. I chalked it up to a busy call schedule and long hours. I mentioned it to some colleagues over lunch. The response was unanimous that I must be under stress and that I needed a vacation. Then I lost my appetite. I had blood drawn and found my liver enzymes were elevated. I walked to the gastroenterologist's office and had her examine my abdomen. Then I stopped by radiology and ordered an ultrasound. I racked my brain to recall any needlestick exposures and sent off a hepatitis profile.

While I worried, I called a friend who diagnosed mononucleosis over the phone. It was confirmed, and I recovered quickly. No harm was done, but I would have been diagnosed more quickly and efficiently if I had acted like a patient and not a doctor.

Twenty minutes later, Dr. M collapsed in a hallway, hitting his head as he fell. He awoke and slowly found his way back to our office adjacent to the hospital. His lip was bleeding when I found him, and he was hypotensive, diaphoretic, and barely coherent. He refused to go to the emergency department. I pleaded with him and secretly hoped he would lapse into unconsciousness, at which point I would call 911. I sat next to him on the floor, thinking he could die.

Dr. M implored me to give him an antihistamine and a shot of steroid to treat his presumed allergic reaction. I paged a surgeon to come up with a suture kit to stitch his lip. He recovered rapidly and without sequelae, and promised not to put himself or me in this situation again. Antibiotics are not appropriate for viral infections - even for doctors.

One other story ended in an alarming way. The vice president of medical affairs for a local hospital, Dr. P had been on steroids for temporal arteritis. One weekend, he became acutely ill with a high fever and shaking chills. While febrile, he became confused and fell out of bed. Anyone else would have sought emergency medical care. But Dr. P refused to call 911. His wife called the neurologist under her husband's direction, but the neurologist could not convince him to go to the hospital. The neurologist jumped in his car to go to Dr. P's house. On the way, Dr. P fell out of bed again and became unconscious. His wife called 911, and in the emergency room, Dr. P was in septic shock with Staph aureus meningitis. With aggressive fluid resuscitation and antibiotics, he survived. After a prolonged rehabilitation, Dr. P is back at work.

We preach to our patients the importance of seeking medical care for their health issues. We as doctors are no different. We are not immortal, and when sick, we may not exercise the best judgment. When a doctor treats himself, he has a fool for a patient.

KAREN B. WEINSTEIN, MD FACP Associate Program Director, West Suburban Medical Center Oak Park, Illinois

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