It seems that no one ever stops to think about doctors actually being patients themselves. The patient is the one who needs to see a doctor, who is healthy and will make you healthy. But doctors are also human, just like their patients, and just as vulnerable to ill health. In fact, most aging doctors are already patients themselves to another doctor, who in the midst of treating their patients may be seeing their own doctor on the side for anything from diabetes to high cholesterol to hypertension.
How does it feel to be on the other side of the system? For most of us, we probably know what it feels like to be on the patient side, since most of us aren't doctors. As a medical student, I know that I as well as many of my class have had those "hypochondriac moments", where we suddenly believe we've discovered signs of terrible illness in our own bodies. We know just enough to be dangerous. Luckily it is just our own wild imaginations taking one minor symptom of a disease and jumping to conclusions without satisfying all the rest of the diagnostic criteria. This week however, my imagination wasn't too far off the mark.
Last Monday I was taking my regular run through my neighborhood. It was evening, and I was doing a usual out and back along the highway. I was going over in my mind all the new medical knowledge that I will later be expected to remember for test week, and trying to unwind the day. The next day we were to learn how to auscultate the heart and lungs - a.k.a. listen to a patient's heart and lungs with our brand new stethoscopes. This is a far bigger deal than you might think though; a doctor could never be convincing if he or she didn't know how to use a stethoscope, right? After my run I showered and was lying in bed attempting to practice my heart auscultation points to hear each of my heart's valves. I was listening in the quiet dark, when I started to wonder if the slight blowing sound I heard between the regular "lub-dub" sound was normal or not. To me, it sounded far more like a "thoosh-boomp" noise. I dismissed it and went to bed, assuring myself it was the same imagination that had convinced me of having numerous other maladies already.
Tuesdays are when my small lab group has class to learn physical exam. Our tutor is Dr. Randolph*, a bona fide M.D. He asked if I would be comfortable with my shirt off in order to demonstrate the physical exam of the heart and lungs this week, to which I agreed. While lying on my back and having my heart listened to, I started wondering about the sound of my heart the night before; would it turn out to be something serious? When Dr. Randolph took off his stethoscope and announced, "Well we have a surprise, he's got a heart murmur!" I felt both surprise and the feeling of finally having your suspicions realized. I gladly allowed my classmates to take turns attempting to hear the murmur, and Dr. Randolph did not seem to appear the least bit concerned at the discovery. However my imagination had now been realized with the sound I could hear in my heart. That night with the house to myself, I became fixated on attempting to self diagnose my murmur via audio resources I had available to me.
A medical student with access to medical literature attempting to diagnose a problem they have is a very scary thing. A large amount of diagnosis comes from having seen what you are diagnosing before, and that only comes with real world clinical experience. A student doctor has little if any clinical experience before beginning their medical education, and so a description of a vague symptom or rare disease could be interpreted in so many ways it is not useful until a living example is seen, and the description suddenly realized. In my own case, I began to read about mitral valve prolapse, mitral valve regurgitation, aortic and pulmonic stenosis (you can look those up yourself if you’d like) and the corresponding treatments and problems associated with the condition. Of course, there’s a high likelihood that my murmur may be innocent, but then I ask a large number of other questions. Why wasn’t this found when I was a kid? Or when I was in highschool and had yearly athletic physicals, why wasn’t it heard then? Is this somehow a newly developed problem? Is it a problem? Will the doctor blow me off as a medical student with a wild imagination when I go in on Friday? That can give you a pretty good summary of where my mind has been going lately.
I made an appointment with the student health center for this coming Friday to talk about my heart murmur and determine if it is anything to be alarmed about. I am only a student doctor at this point, but to be put in the role of patient will mean giving up my sense of control. It will also mean trusting the doctor, despite the knowledge that they may be incorrect. I will have to be careful not to try to look for disease in me that isn’t there, and be assured that it may be of no concern at all.
*The name has been changed in order to protect the privacy of the physician
