July 21, 2017

The 3 biggest problems when doctors become patients

Daily Briefing

Physicians often encounter difficulties caring for patients who are also doctors, particularly if the patients are colleagues as well—but there are strategies physicians use to address these obstacles, according to a new study in Family Medicine, Carrie Noriega writes for Medical News Today.

5 myths physicians believe about patient experience

For the study, researchers interviewed family medicine and general internal medicine doctors about their experiences treating physician-patients and the strategies they used to care for such patients.

Common challenges

The researchers identified three common obstacles, as well as three strategies physicians said they used to address them:

  1. Making assumptions about a physician-patient's knowledge of his or her condition

    According to the study, physicians said they provided a different level of care to their physician-patients than they did their regular patients, largely based on the assumption that their physician-patients were better informed about their own condition, knew when to schedule follow-up care, and generally made good lifestyle choices.

    For instance, some physicians said they assumed their physician-patients would disclose all the information needed to care for them. As a result, the providing physicians said they asked fewer questions and sidestepped more sensitive issues—which the researchers said could lead to a diminished quality of care.

    Further, according to the study, some physicians felt that their physician-patients were judging their performance differently than a regular patient would. In turn, the providing physician did more rigorous exams and ordered more tests than necessary, potentially leading to excessive care.


  2. Managing conflicting opinions on care

    According to the study, physician-patients have more familiarity and access to medical information than their non-physician peers, including ready access to self-referrals, personal test results, and "curbside communication" from informal discussions with other physician colleagues. Noriega writes that while this knowledge can be beneficial, it can also create confusion about how best to incorporate a physician-patient's medical knowledge into his or her care.

    For instance, while some respondents said such curbside communication could actually help move the care process a bit faster, others expressed concern that it usually didn't involve documentation, formal evaluations, or follow-up. "Those aspects are why I say that I think physicians often get poorer health care than traditional patients, and I will not do (curbside consultations)," the respondent said.

  3. The changing physician workforce

  4. Maintaining appropriate boundaries between working as colleagues and working as a provider and patient
  5. While many physicians said they've maintained comfortable, well-defined roles while providing care for physician-patients, others acknowledged that they felt uncomfortable or awkward providing care for someone who is a colleague. In addition, once they learn more about a colleague's medical conditions, particularly if the information is sensitive, it can be difficult for the providing physician to maintain the formerly professional relationship, Noriega writes.

    For instance, one provider in the study said he or she was challenged in discussing sensitive medical information with a colleague. "If I'm taking care of a colleague in my own department [who] I know fairly well, sometimes it's a little uncomfortable to talk about mental health issues or domestic violence or substance use or sexual risk factors," the provider said.

    Separately, another respondent said physician-patients might feel uncomfortable about disclosing medical issues because of confidentiality concerns. "I think sometimes there's a reluctance on the part of other physicians to disclose things when they go to see their health care provider because they're always worried about the medical record and who's going to have access to it," the respondent said.

3 ways to address providers address the challenges

The researchers identified three common strategies respondents used to address such challenges, all of which relied on clear communication with the physician-patient. The strategies included:

  1. Ignoring the physician-patient's background

    Some physicians in the study said they tried to "de-doctor" their physician-patient—in other words, they treated them as they would any other patient, dispelling any preconceived notions they might have about what the physician-patient knows or does not know.

    One respondent said, "I do give the physician-patients a little disclaimer. I just say, "Hey, I'm going to treat you like every other patient, some of the things might be embarrassing or frustrating, but we just have to get through it."


  2. Acknowledging the physician-patient's background and negotiating a care plan

    According to the researchers, other providers said they acknowledged the physician-patient's background and negotiated a treatment plan acceptable to both parties.

    For example, one respondent said, "There's probably a little bit more negotiation in some cases ... I had

    to talk with (a physician-patient) about, 'What would you prefer to take?' and balance that with what I think was best for her."

    Open communication was key, the providers added. As one respondent put it, "Open communication is critical. And I think it actually helps physician-patients feel more reassured there's no assumptions or corner cutting going on in their care."


  3. Allowing the physician-patient to drive care
  4. Some providers said they preferred to cede most decision making to the physician-patient, unless a particular choice countered the provider's philosophy of care. However, the researchers found that "this strategy often resulted in physicians providing special favors for physician-patients or altering their strategy of care to accommodate the physician-patient."

    For instance, one provider said, "I have a physician who is taking a medication" and who "sometimes wants refills without being seen, and I get uncomfortable with that and I think you should be seen at least once a year and usually I'm trying to insist on that but, you know, it's hard to do with a peer" (Noriega, Medical News Today, 7/12; Domeyer-Klenske/Rosenbaum, Family Medicine, July-August 2012).

5 myths physicians believe about patient experience

Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they’re all driven by the physician as the “Influencer in Chief.”

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