Navigating healthcare as a doctor: ‘I wish I could approach health scares with the same blind optimism as nonphysicians'
Key Takeaways
As physicians, we never want to be on the other end of the stethoscope. Before I had to navigate healthcare myself, I believed that the system was fair and equitable. Maybe I was young and naïve.
Maybe, I simply wanted to believe in the system that I had worked so hard to be a part of. But I was healthy. My family was healthy. And maybe—just maybe—I felt a little invincible because of that.
Confronting health scares at home
But then it happened. Last year, my father—a retired physician himself and an actual Ironman—got sick. It started with leg pain and swelling after a long run. Probably just a strain. Maybe a muscle tear. Nothing serious. But when the swelling got worse, we all made him go to the ER. He spent 12 hours there and spoke with a physician for only minutes of that time.
I remember his voice so clearly on the phone on his way home: “I have a very large DVT and multiple bilateral pulmonary emboli.” He was discharged with a 2-week script for an anticoagulant and told he’d have a referral to the thrombosis clinic as an outpatient.
Because he was a physician, he was given very little instruction otherwise. They checked his O2 saturation, made sure he wasn’t imminently dying, and sent him on his way.
Physicians in the family
As a “physician family” (my father, my sister, and I are all physicians), we immediately assumed the worst—he must have metastatic cancer. I instantly picked up the phone and got him an appointment closer to me to have a CT scan and follow-up. He saw several physicians and received fantastic, thorough care. Luckily, there was no cancer. But he never did receive that call for thrombosis follow-up.
"We couldn’t help but wonder: If he hadn't been a physician who knew better, would he have received the same care and instructions?"
— Courtney Manser, MD, CCFP
Would he have gone home, not knowing any better and stopped his anticoagulant 2 weeks later when the script ran out, assuming all was fine? Or was the care actually worse because he was a physician, and they assumed he would just know better?
Sometimes, we know more than we should
Then, a couple months ago, it happened again. This time, it was my mother. Another trip to the ER. This time, it was the worst-case scenario. Stage 3C ovarian cancer. As a close-knit family, to say we were blown away and devastated would be an understatement.
It’s funny how grief can truly cloud any practical thought. But luckily, the care was excellent this time around.
Not to say there weren’t “holes in the system”—we still had to wait 3 weeks just for a biopsy, but so did everyone else receiving medical care. But my mother’s oncologist was fantastic. She did not assume we know anything more than the average person, just because we are a family of physicians.
But still it’s difficult, because we’re usually the ones providing treatment. We constantly question: Should we pick up the phone? We don’t want to overreact or bother them. We read study after study and we know more than we’d like to most days.
"Sometimes, I wish I could approach health scares with the same blind optimism as most people who aren’t in the field."
— Courtney Manser, MD, CCFP
In both instances, I struggled with the treating physician’s knowledge that we were physicians ourselves. Would it impact how much we were told because they would assume we already knew? Would it, in fact, get us access to better and quicker care, as it seemed to be in the case of my dad? Was it ethical to skip the line?
"Many jobs have “insider perks”—shouldn’t we, as physicians, get these as well?"
— Courtney Manser, MD, CCFP
Or would it hinder our care by intimidating the provider, clouding their judgment?
Managing expectations
In navigating healthcare, physicians must consider opposing ideals and expectations.[] We want to advocate best for our family members, and we want to be the ideal conscientious physician, but we also have to deal with both the expectations of family and those of other physicians. The system is flawed, and role conflicts abound.
"We need an ethical code to navigate the system, while acknowledging and not disregarding those flaws."
— Courtney Manser, MD, CCFP
Then, there is the financial side of it all. Although I am Canadian myself, I am aware of the added barrier that patients, including physician-patients and their family members, face with regards to insurance and medical costs.
Physicians working in the US understand the ins and outs of health insurance companies and how to navigate the financial aspect better than most of the public. It’s been proven that people with better health insurance coverage receive more appropriate and adequate care, and that uninsured individuals have poorer clinical outcomes.[] In fact, in a study of PCPs’ perceptions of their patients’ insurance status, 88% of surveyed PCPs reported making a change in their clinical management decision based on whether the patient was privately insured, publicly insured, or uninsured.[]
Knowing what is needed and having the financial ability to obtain it allows physicians the opportunity to access what they need, when they need it—for both themselves and their family members.
Overall, we’re at an advantage
Some studies show that being a physician-patient may actually be an advantage, leading to better clinical outcomes.[] And yet, it’s never fun to be on the receiving side of healthcare.
"Being on this side has opened my eyes to the flaws in the system and posed many more questions than answers."
— Courtney Manser, MD, CCFP
It has made me more aware of the way I communicate with my patients, and of the need to provide a comprehensive discussion regardless of their background. It has also made me a better advocate for my patients, because we all deserve a chance at the best possible outcome. But most of all, it has made me a better listener. I hear my patients’ frustration with the system, and now I finally understand.
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