Q: What Scares Doctors? A: Being the Patient

What insiders know about our health-care system that the rest of us need to learn

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It's easy to imagine that doctors don't get sick. Surely the hygienic shield of the sterile white coat guards them from ever having to put on the flapping gown and flimsy bracelet, climb meekly into the crisp bed and be at the mercy of the U.S. health-care system. And if somehow they did enter the hospital as a patient, physicians ought to have every advantage: an insider's knowledge, access to top specialists, built-in second opinions, no waiting, no insane bureaucratic battles and no loss of identity or dignity when you turn into the "bilateral mastectomy in Room 402." But it doesn't usually work that way. While doctors are often in a better position than most of us to spot the hazards in the hospital and the holes in their care, they can't necessarily fix them. They can't even avoid them when they become patients themselves. When Dr. Lisa Friedman felt the lump in her breast in the summer of 2001, she did--nothing. "I just sat on it," she says, "because I clicked into the mode of being physician, not patient, and I thought, 'Most lumps are not cancer, I'll just watch this.'" That was her first mistake.

By September Friedman had watched long enough. An internist in a practice that covers much of southern Wisconsin, she went to her radiology department to schedule a mammogram. The administrators turned her down: her HMO paid for routine mammograms every two years, and she'd had one 18 months before. "I said, 'Wait a minute, I feel a lump. This is not routine.' They still wouldn't let me do it."

This is the stuff bad movies are made of. Friedman had to appeal to the HMO's board of directors. "I said, 'I'll pay for my own mammogram. Just let me get it done.'" She won her appeal and finally had the test. "They didn't even have to do a biopsy," she says. "The radiologist just looked at it and said, 'Oh, my God. You've got breast cancer.'"

The education of Lisa Friedman, patient, had begun. Like any other patient--and perhaps even more so--she had to drag information out of her physicians. "They were treating me like I was knowledgeable, but they weren't listening to me." When she found out that the cancer had spread to several places in one breast, Friedman told her surgeon there was no need to preserve her breast for cosmetic reasons; she was more concerned that the cancer be entirely removed. She asked for a mastectomy--but she was told that a lumpectomy would do the job fine. "I went along with it," she said. That was her second mistake. Her breast was riddled with tumors. "They ended up doing three lumpectomies. They were cutting away at my breast until I had no breast left. I said, 'Will you please take it all off?'"

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