Off With the White Coat, On With the Backless Gown

I've said many times, only partly joking, that every doctor's training should include a few days in the hospital being treated exactly like any other patient. (After that, a day or two every 10 years should be a continuing education requirement.) There's no other way to taste the fear that comes from half-overheard mumbling just outside your door, the frustration from pressing a call button that might as well be disconnected, the fury from being patronized ("And how are we today?"), and the passivity that comes from being treated as a condition and not a person.

Ask and ye shall receive. Not mandatory hospital stays for budding M.D.'s—those are still on hold. But a new book by psychiatrist Robert Klitzman, When Doctors Become Patients, burrows inside the heads of physicians who have been seriously ill.

Klitzman conducted deep interviews with 48 doctors, from a surgeon with breast cancer and an anesthesiology resident with HIV to a neonatologist who'd had a heart attack and a pediatrician with Hodgkin's lymphoma. Once they accepted the reality of their illness (not all did), a few set aside their medical degrees and settled into passive patienthood, ceding responsibility for their care to others. A radiologist with skin cancer didn't even search the journals for the latest findings. "I'm a picture reader, not a symptom finder," he told Klitzman. His wife looked through the professional literature instead. "I better not bother the doctor and ask too many questions, because he'll get offended" is how another physician described his attitude. Others took refuge in denial, like the neurologist with HIV who refused to be told his lab results. Still others, because they were part of the system, worked it hard. They arranged speedy referrals to top specialists and picked up the phone to tap experts for their opinions.

Guess what: Doctors don't like being patients. An oncologist with cancer wouldn't wear a hospital gown, only scrubs. "It's very strange to sit there in a hospital gown with my butt hanging out," he complained. (No kidding.) Another wanted more warmth from his doctor than he got. "He wouldn't say, 'The outlook is good,' " said this doctor-patient—rather, "The CT is negative." Facts only.

Some hospitalized physicians, writes Klitzman, "came to realize—often painfully—that reputation alone was insufficient in choosing a doctor." An internist who had cancer recalled to Klitzman how a lionized superspecialist "wrote a note in my chart when he didn't even see me!" I didn't share her shock, nor, I'm sure, will others. Those bills from specialists who patients can't recall seeing? Could be the specialists were never there.

My idea of putting docs in the hospital isn't an attempt at rough justice (maybe a little of that). It's more so they can understand what it's like, perhaps sowing an empathetic seed. This did happen with many of the physicians in the book, as evidenced by comments like "I cut patients more slack," "I've become like a social worker," "[I try] to be gentle when I give bad news." One doctor whose husband had died said, "Now I put myself in my patients' clothes. When I talk to them, I really talk to myself: How would I react?"

The writing is formal and analytical but not impenetrable, and getting past the stiff style is worth the effort. The doctors Klitzman interviewed seem to have experienced life-altering shifts that went beyond the fact and effect of their illness. They were on the other side of the desk; they were horizontal; their powers had been circumscribed. They were patients.