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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Friedman's doctors weren't incompetent. They didn't operate on the wrong breast or give her the wrong drugs or commit any egregious medical errors--and that is the whole point. While there are bad doctors practicing bad medicine who go undetected, that's not what scares other physicians the most. Instead, they have watched the system become deformed over the years by fear of litigation, by insurance costs, by rising competition, by billowing bureaucracy and even by improvements in technology that introduce new risks even as they reduce old ones. So doctors resist having tests done if they aren't absolutely sure they are needed. They weigh the advantages of teaching hospitals at which you're more likely to find the genius diagnostician vs. community hospitals where you may be less likely to bring home a nasty hospital-acquired infection. They avoid having elective surgery in July, when the new doctors are just starting their internships in teaching hospitals, but recognize that older, more experienced physicians may not be up to date on the best standards of care.

Most doctors freely admit that they do everything they can to work the system. "As much as we all value fairness, if you think you can get some special attention for someone who's important to you ... I don't know anybody who would not play that card," says Michael McKee, vice chairman of psychology and psychiatry at the Cleveland Clinic. But talk to doctors about their experiences and you'll be surprised by how little power they have to bend the system to their will.

This is one abiding irony of progress. The most wondrous technology exists that can pinpoint the exact location of a tumor, thread a tiny catheter up into the brain to open a clogged artery, pulverize a kidney stone without breaking the skin. But the simple stuff--like getting an MRI on time, being given the right drugs at the right time, making sure everyone knows which side of your brain to operate on--can cause the biggest problems. "A patient with anything but the simplest needs is traversing a very complicated system across many handoffs and locations and players," says Dr. Donald Berwick, a pediatrician and president of the Institute for Healthcare Improvement. "And as the machine gets more complicated, there are more ways it can break."


"Doctors are terrible patients because they know too much," says Dr. Pamela Gallin, director of pediatric ophthalmology at New York Presbyterian-Columbia Medical Center and author of How to Survive Your Doctor's Care. "They can't be both doctor and patient at the same time." They don't like appearing weak; they are schooled in a culture of stoicism and sacrifice that cautions against complaint. In studies of the behavior of doctors, most admit to writing their own prescriptions, self-diagnosing, avoiding checkups. When they do have to enter a hospital as a patient, they struggle with their role, scanning their bedside monitors and watching their colleagues so closely that everyone can get a little spooked. "I don't like the role reversal," says McKee. "I suppose it's the way you feel when you're 80 or 90 and your kids are taking care of you. It doesn't feel right."

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