Two Secrets Your Doctor Will Never Tell You

It was 7 pm. I’d already had a big day at the hospital with surgical rounds in the morning and a busy clinic in the afternoon.

But my on-call night of surgery was just beginning. As I sat in the hospital cafeteria, in front of a plate of rice, broccoli and chicken, enjoying my first forkful of rice, sighing with relief at a welcome rest, my pager went off. It was the emergency room calling me for a 61year old patient short of breath. I had to come immediately. I grabbed my dinner plate, stashed it in the on-call room where I had a bed, then rushed to the ER. The technician had already done an X-ray which showed fluid in the pleural cavity. The patient needed a chest tube to drain the excess fluid out of his lungs.

As I got ready for the procedure, my pager went off again. Surgical ICU messaged that a patient who’d been operated on earlier for gunshot wounds to the abdomen had a sudden drop of blood pressure.

I told the nurse to page my attending physician to decide whether the patient was bleeding internally and would need more surgery. After placing the chest tube, I run to the ICU, only to learn I needed to scrub in to re-operate on the gunshot wound patient.

As I was in the middle of the surgery, the ER paged me again. I had two new patients I needed to examine, one for possible appendicitis, the other one for possible gallbladder problems.

I finished the surgery at 2 am and dashed to the ER to examine the two new patients. One of them had an acute appendicitis and needed immediate surgery. I sent the other one for an abdominal ultrasound.

When I finally emerged from the operating room, it was 5 am. Would I have time to eat the rest of my dinner? Would I have time to sleep 15 minutes? 30 minutes was probably too much to ask for, but 15 minutes would be so welcome.

Back in my on -call room I had a choice, eat my cold dinner or lie down.

I chose to lie down, and fell into a deep, dreamless sleep.

My pager woke me. The ICU was saying that my patient was agitated and had yanked off a fluid and antibiotic line from a deep vein in his neck. I had to place a new line.

I looked at the time. I’d only slept 20 minutes. But I was grateful that I’d gotten more than 15 minutes sleep.

I placed a new line in the patient’s right jugular vein, then headed off to my morning rounds.

When morning rounds mercifully came to an end, I drove home, hungry and exhausted.

And almost fell asleep twice behind the wheel.

Somehow I managed to get home safely, but didn’t bother to eat. Instead, I staggered upstairs to my bedroom and crashed.

Sleep was essential because I had to be on call 14 more times that month

My story is not unique. Many physicians live this kind of hectic existence: pressure, chaos, and constant life or death decisions on top of the routine stresses of family, relationships, child rearing and office politics.

This lifestyle leads many doctors to keep secrets from their patients: I’m going to share two of them to help you help your doctor.

First secret: Many physicians are severely stressed out and depressed.

Even physicians who don’t routinely handle multiple hospital surgical crises lead hectic lives. Most see 30 to 40 patients every day and can only allow 15 minutes per patient. Fifteen minutes to ask you what is wrong, which medications you are on, perform a thorough examination, prescribe tests and treatments and type all this into the computer. This schedule leaves about 3 minutes for each task, ignoring interrupting phone calls and possible emergencies. And even doctors who aren’t surgeons or ER specialists spend many nights on call without much sleep.

Who wouldn’t be stressed out with that schedule?

There is mounting evidence that many family physicians suffer from occupational stress. The term burnout has come to mean emotional exhaustion, depersonalization, and a perceived lack of personal accomplishment. In Canada, a survey of rural family physicians in 2001 showed a self-reported burnout rate of 55%; a survey in 2004 demonstrated that almost half of urban family physicians self-reported experiencing high stress levels and components of burnout.

Chronic stress that doctors experience harms their bodies through constant overdose of hormones such as cortisol and adrenaline. One of the most damaging long-term effects of stress hormone overdose to the brain is depression.

So it’s no surprise that, on average, the United States loses as many as 400 physicians to suicide each year (the equivalent of at least one entire medical school).

Also, after accidents, suicide is the most common cause of death among medical students.

Depression is higher in the medical profession than in the general population, affecting an estimated 12% of males and 18% of females. Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms.

A 2011 survey of 50,000 practicing physicians and medical students in Australia demonstrated a dramatically increased incidence of severe psychological distress and a twofold increased incidence of suicidal ideation in physicians compared with the general population.

To cope with stress and depression, some physicians turn to alcohol or prescription drugs, because doctors have easy access to medications.

But you, as a patient, won’t know any of this. All you’ll notice is that your physician seems rushed, doesn’t spend much time listening to you or explaining what you are suffering from or how to fix it.

How can you help your physician help you?

• He or she only has 15 minutes for you, so be as brief, concise and straight to the point as possible. Rehearsing what you want to say will help you do this.
• Write down all your symptoms and the history of how and when they started. Summarize everything in a few easy-to-read lines.
• Have the list of medications you are taking, as well as their dose, ready to read.
• Write down before your office visit the list of questions you want to ask.

This will make your physician’s task much easier and will help him or her relax a bit. Your doctor might still be stressed, just not stressed by you!

The next secret reveals why this is vitally important to your health.

Second Secret: Physicians make mistakes.

Even the best physicians from the best medical schools make medical mistakes. The most common mistakes are diagnostic errors, but doctors also chose the wrong treatments or simply forget to read the result of blood tests or X-rays. If you don’t hear from your doctor about an X ray, you might assume the X-ray was normal, when in fact, it was not normal.

Chronic stress, depression and substance abuse increase the chances that your doctor will make such an error, so my previous advice– that you take pressure off of your doctor by saving your doctor time– is doubly important. When your doctor is less pressed for time, he or she will make fewer mistakes.

Here are other things you can do to protect yourself from medical mistakes:

• Ask your physician what your diagnosis is and why. If it doesn’t make sense to you, don’t be afraid to get a second opinion.
• Ask which medication he or she is giving you, how it is spelled out and which dose is being prescribed. Sometimes, the pharmacy will give you the wrong medication or the wrong dose of the right medication. Make sure that what your pharmacist gives you is the same thing that your physician prescribed.
• Ask your physician to comment on your latest blood test and/or X-ray result and always ask for a written copy of your results (just in case something is highlighted as abnormal but overlooked by your physician).

In summary, although doctors are highly trained and experienced, knowing the stresses that they face can help you help them help you.