When I was a very young child, returning from a visit to my doctor, I remember wondering “who does the doctor go to when he or she is sick?” Although physicians may think otherwise, they too are human, and certainly not invincible to the ailments that plague the rest of us! So, it became apparent to my young mind that at some point doctors would have to visit other doctors for treatment. Undeniably, these situations arise daily, posing great challenges to both the physician-patient and the physician. The dilemma of treating a fellow physician can be so exigent that physicians have often been described as the “worst patients” [1].

What challenges are involved in treating physicians? In order to answer this question, we must understand some of the constraints the role of the physician as a patient may place on the physician-patient relationship. Studies conducted on this subject suggest that treating physicians is difficult because of their extensive (and expensive) medical knowledge, ingrained professional role, self-image, and autonomy. Thus, physicians may have earned the title of being the “worst patients” inadvertently, by virtue of their profession, not their personality. Because it is often frustrating to treat physicians, we must bring to light mechanisms by which physicians can cope with their “worst patients.”

The opportunity for a physician to care for another physician is both an honor and a challenge [1]. It is a tribute because the physician who serves as the doctor’s doctor has been recognized for his skill as a professional [1]. The chosen doctor is esteemed because he has been able to follow the teaching of the Hippocratic Oath, which states, “I will keep this Oath and this stipulation to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required” [2]. Yet, at the same time, this opportunity poses a challenge because physicians are not typical patients [1]. In contrast with the average patient who comes to the doctor with little or no knowledge of the implications of his symptoms, physicians form an elite group of patients because they are as knowledgeable as their doctors on medicine.

As a result of the physician’s near equal knowledge as his doctor, physicians generally do not respond well as patients [3]. Physicians hold their own ideas on diagnoses and treatments, so they are often not as acquiescent to their doctor’s orders as normal patients [1]. They may interject with their own demands or even reject their doctor’s stipulations [1]. The equity of knowledge between the two parties can render the physician-patient relationship a power struggle, with each physician striving to control the relationship [3]. One doctor, who was being treated for carcinoma, comments, after returning to his clinic, “‘Yesterday, I was a doctor again. Oh, what a feeling to be there for another human being’” [3]. The battle between the physicians can be detrimental to the physician-patient relationship because the authority of the care-giving physician is challenged.

The physician’s superior medical knowledge in comparison with that of a typical patient may also cause him to display increased anxiety about his health, which may interfere with the physician-patient relationship [3]. The phenomenon of “medical student’s disease” often does not end with being a medical student; doctors tend to envision the worst possibility for a given symptom. For example, Schneck’s article, “‘Doctoring’ Doctors and Their Families,” suggests that doctors can interpret muscle twitches as amyotrophic lateral sclerosis [1]. Other doctors remark, “‘One minute you think it’s just a headache, next minute you’re sure it’s a brain tumor’” [4]. This greater degree of anxiety may cause doctors to delay visiting a physician, as well as make them overly paranoid in the physician-patient relationship [3]. Such fear can further influence the sick physician to hide pertinent facts from his doctor or become obsessed with the quality of the medical care [1]. The sick physician is also prone to the VIP (very important person) syndrome, where he heightens the nature of his condition and becomes demanding [3]. A physician who has succumbed to the VIP syndrome makes the task of healthcare professionals difficult, because he may refuse to follow the medical routine of the hospital [1]. Anxiety produced by the immense medical knowledge of a physician can therefore obstruct the physician-patient relationship in manifold ways.

Moreover, because physicians spend the majority of their lives caring for the health of others, they often cannot accept that they are sick and in need of medical care [3]. “‘Doctors feel they shouldn’t be sick . . . you don’t want to go and see your local psychiatrist in case one of your patients is sitting beside you,’” suggests a study by Thompson et al [4]. Doctors do not respond well to the phenomenon of role-reversal because their professional identity is deeply ingrained within them [3]. The rigor of medical education causes them to esteem their professional identity, sometimes to the point that all aspects of their lives revolve around medicine [1,3]. Many doctors are afflicted by the “‘disease of being a doctor’” [1], and so they cannot view themselves as anything but a physician. Consequently, when physicians are forced to become patients, they find it difficult to accept the role.

The myth of the physician as a superhero, invincible to all illnesses, also contributes to the physician’s difficulty in becoming a patient. Doctors often downplay the gravity of their own health conditions to others, since they are used to being the ones who treat the sick, not being the sick ones themselves. “‘We think we’re superhuman and that we don’t get ill, or if we do, we can cope with it,’” suggests a doctor in a study by Thompson et al [4]. Because of this superhero myth, physicians often feel that seeking medical attention is a sign of their incompetence as a physician [3]. This issue surfaces even when members of the physician’s family are in need of medical assistance, as the physician often feels embarrassed that his loved ones have had to seek care elsewhere and that he has somehow failed as a physician since a member of his family has fallen ill [3]. Adding to the superhero myth, doctors tend to be perfectionists by nature, so weakness of any sort is frowned upon [3]. Thus, physicians can often live in outward denial of their medical conditions, even while being obsessive about their symptoms, because of their self-image [1].

Society reinforces the superhero myth, making it even more difficult for the physician to see himself as a patient. The physician is viewed as the healer of society, the chosen one, “to watch over the life and health of [all] creatures” [5]. Patients try to pretend that their physicians are not ill, even if they are visibly so [1]. After all, who wants to visit an ill doctor? Doctors are thus socially expected to be care-givers and never care-receivers. As some doctors remark, “‘illness [in the hospital or even medical school] was not really tolerated and you were expected to do the job’” [4]. As a result of society’s refusal to acknowledge the health of the physician, most physicians generally want as few people as possible to know about their health conditions [1]. Doctors fear that visiting a physician will breach their confidentiality, which prevents them from obtaining the medical help they need. Society’s reluctance to support the well-being of the physician is also reflected in the current medical economic system, where illness in the physician can lead to increased malpractice insurance [1]. In many ways, society sets up the physician to be the “worst patient.”

Physicians may also be the “worst patients” since they have access to self-treatment. Despite Osler’s warning that “the physician who doctors himself has a fool for a patient” and the American Medical Association’s Code of Ethics which advises against self-treatment [6], many doctors feel that it is unnecessary for them to visit a physician since they can self-prescribe medications and consult with colleagues [3]. Even in situations where the physician visits a doctor, he can override his doctor’s orders with his own stipulations [3]. As a result of the physician’s power in the medical system, the physician can be prone to drug and substance abuse, since such compounds are readily available at the hospital setting or through prescriptions [6]. Thus, the ability of the physician to self-heal can further complicate the treatment of physicians.

Evidently, there are many factors that challenge the well-being of the physician-patient relationship when the patient is a physician. How, then, can doctors overcome the dilemma of treating other doctors? Physicians such as Schneck and Fromme offer suggestions based on their experiences with caring for other doctors. They advocate defining the physician-patient relationship as soon as possible, and letting the physician-patient know that he will be treated respectfully as a patient [1]. This includes making clear that his privacy will be protected, especially when the physician is being examined at his own clinic or hospital [3]. Moreover, the care-giving physician should show the other physician that he is aware that problems may crop up in their relationship, but that he is willing to work through these problems by compromising with his patient [3].

Having elucidated the physician-patient relationship, the care-providing physician must then examine the physician-patient as objectively ashe would examine any other patient, taking care to involve his patient in the process [1, 3, 6]. Fromme proposes that the physician-patient relationship be negotiated in such a manner that the physician-patient is able to help direct his care [3]. It is also important for the doctor’s doctor to maintain control over the relationship, while respecting his patient’s medical experience and not being overbearing [6]. The care-providing physician should take care to discuss the mode of treatment and keep the patient informed of his condition [1]. Allaying the fears of the physician is also necessary, as well as maintaining an empathetic, yet objective outlook on the situation [6]. Ultimately, a healthy physician-patient relationship can be cultivated if the care-providing physician respects his patient, being understanding to his situation while serving him as faithfully as he would serve any other patient.

Physicians can also help improve the treatment of other physicians, by following the advice of the ancients. Maimonides states, “Let [the physician] never see in the sufferer anything else but a fellow human being in pain” [5]. Doctors may be capable of superhero-like actions, but ultimately they are as human as any other patient. Thus, it is imperative for the doctor’s doctor to understand the feelings of the physician he is treating. While physicians may be the “worst patients” because of their extensive medical knowledge, professional identity, self-image, socially ingrained role, and ability to self-doctor, they are undoubtedly the best doctors, so the task of treating a physician, while challenging, is definitely not impossible with persistence and understanding.