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When doctors become patients

Article in Journal of Clinical Investigation · May 2008


DOI: 10.1172/JCI35627 · Source: PubMed Central

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Ira B Wilson
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Book review

When doctors become patients


Robert Klitzman
Oxford University Press. New York, New York, USA. 2007.
344 pp. $35.00. ISBN: 978-0-19-532767-0 (hardcover).
Reviewed by Ira B. Wilson
Tufts–New England Medical Center, Boston, Massachusetts, USA.
E-mail: iwilson@tufts-nemc.org

R obert Klitzman’s book When doctors


become patients records the experiences of 70
medicine. Thus, aspects of each physician’s
story surface, usually, in multiple sections.
small reassurance that even doctors, when
ill, experience these indignities.
“wounded physicians” (to use Carl Jung’s Appropriately — because the method is This book, as intended, raises far more
term). Through these stories, the author qualitative — Klitzman lets these physicians questions than it answers. This is illustrated,
seeks new insights into being a physician, tell their own stories. The text is dominated for example, as these wounded physicians
being sick, and the functioning of the by excerpts from each physician’s inter- describe how they think about their respon-
health care system in the United States in views, usually 2- to 3-paragraph segments sibilities toward their patients. On the one
the early 21st century. that illustrate specific points. The book’s hand, there are condition-specific issues
In the introduction, Klitzman writes chapters are thus a series of vignettes woven such as what types of care physicians with
“Though the early states of doctor’s careers together to illustrate specific themes, such HIV should and should not participate in
have been examined . . . much less atten- as Chapter 3, “The medical self: self-doc- (i.e., should they do procedures in which
tion has been given to the latter stages of toring and choosing doctors,” Chapter 8, there is some finite risk of bleeding and con-
medical careers and the exact boundaries “Being strong: workaholism, burnout, and sequent infection of a patient?). But in addi-
of the ‘doctor role.’ Little is known about coping,” and Chapter 11, “Us versus them: tion, there are broader issues related to phy-
how they travel back to the lay world from treating patients differently.” sicians’ implicit commitment to “be there”
that of being a doctor, what stages comprise Above all, this is an honest book. To his for patients over time when they themselves
their journeys, and whether their two roles great credit, Klitzman was able to get these may have, for example, a metastatic cancer.
change, blur, or conflict, and if so, how.” physicians to talk bluntly about their experi- What kinds of conversations should physi-
Klitzman uses qualitative methods to illu- ences, how those experiences changed them, cians have with patients about this difficult
minate this journey. He initially conducted and how they tried to doctor differently as a topic? What are physicians’ ethical and legal
20 interviews of physicians with HIV and result. While there is nobility, generosity, and responsibilities? Here the issues faced by phy-
then recruited other physicians through kindness in these stories, there is also frus- sicians are in some ways no different from
the Internet, e-mail announcements, web- tration, selfishness, resentment, and anger. those faced by other personal service profes-
sites, word of mouth, and advertisements Everyone will bring something different to sionals, such as lawyers or accountants, and
in newsletters. The 70 contributors lived the reading of this book, and as a result, each some discussion of or reference to norms in
in several cities in the United States, prac- will take something different away. other professions would have been helpful.
ticed a wide variety of specialties, ranged in For example, I was particularly moved — While Klitzman works hard to extract les-
age from 25 to 87 years, and had a range of and upset — by Chapter 4: “Screw-ups: exter- sons for physicians and patients from these
medical diagnoses, including HIV infection, nal obstacles faced in becoming patients.” accounts, the beauty of the book for me was
cancer, heart disease, Huntington disease, Physicians describe the ways in which their the directness and humanity of its stories.
and bipolar disorder. The author hopes that symptoms were ignored, particularly psy- For that alone it is worth reading. The only
“the lessons these doctors gained can help chiatric symptoms such as depression and aspect of these physicians’ stories that I was
patients and families, current and future anxiety; how their dignity and identity were still waiting for when the book ended was
physicians, other health care professionals, diminished; the various incidences of poor family. A theme that wove its way through
and policymakers.” communication that left them confused and every chapter was the powerful way in which
The book is organized thematically into upset; and the arrogance of treating physi- the identity of “physician” shaped and
three sections that describe the experience cians. As a practicing physician, I could only often dominated these doctors’ lives. I was
of becoming ill (becoming a patient), the cringe as I read, thinking about the times I left wondering how that identity competed
experience of returning to work as a phy- had been guilty of all of these same sins. For with that of son, daughter, father, mother,
sician after being a patient, and how the patients and their family members who read parent, and grandparent. This is a thought-
experience of being a patient changed the this chapter, there will be much that is all ful and carefully written book. Read it. You
ways in which these physicians practiced too familiar, and perhaps there will be some will not come away unaffected.

1588 The Journal of Clinical Investigation    http://www.jci.org    Volume 118    Number 5    May 2008

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