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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You would think doctors have a great advantage in knowing whom to see for their particular problem, and in one sense they do: they can tap into the medical grapevine to find out who has the best reputation and the most experience with a given procedure. They just have to hope that person isn't their colleague down the hall. In a system that can seem infuriatingly impersonal, a little distance is a valuable thing.

Doctors will often choose not to be patients at their own hospital. There's a risk that when treating a colleague, the physicians may lose their objectivity and the patient his or her privacy. The same holds true for anyone who goes to a doctor who is also a friend; you run the risk of losing both. This is the hard fact that doctors know and patients have a hard time believing: it's not just bad doctors who screw up. To an outsider, everything that happens in a hospital has an air of magic, and the people in the coats seem like wizards. But doctors know that physicians are people too, who can get tired, or distracted, or simply one day fall a millimeter short of perfection, sometimes with disastrous consequences.

Dr. Robert Johnson, a busy Southern California orthopedic surgeon, skidded instantly from doctor to patient one day as he walked toward the operating room, scrubbed hands raised, and slipped on a freshly mopped floor. He broke the scaphoid bone in his right wrist, a bone that anchors all the bones in the hand, especially vital for the physically demanding work of an orthopedic surgeon.

So he called on a friend who was a renowned hand specialist. "I knew the procedure well," he says. "Remove the scar tissue and place a tendon from my own body to stabilize the other hand bones." Naked under his hospital gown, Johnson was rolled into the operating room cracking jokes with his doctor. "I felt bad to be a bother," he says. Together Johnson and his friend decided to go with general anesthesia. An hour later, Johnson woke up and said, laughing, "That was quick!"

But his friend the surgeon was distraught. He had used a tool called a rongeur to chew up the scar tissue and had accidentally chewed up the scaphoid bone--ending Johnson's ability to do orthopedic surgery. "The actual damage happened in a matter of seconds," he says. "I heard later that he had told my wife while I was still under anesthesia. She said, 'You go and fix it before he wakes up!' What she didn't know was that there are some things that can't be fixed."

Although Johnson thinks his case was a "rare aberrant fluke," that's not exactly true. More than 1 in 3 doctors in a 2002 survey by the Harvard School of Public Health reported errors in their own or a family member's medical care. Dr. Robert Wachter, chief of the medical service at the University of California, San Francisco Medical Center, who co-wrote last year's best seller Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes, says he has seen it all: patients who had the wrong leg amputated, were given the wrong (and deadly) medicines, had surgical instruments left behind in the abdomen. Not all the errors are due to ignorance or incompetence; even the best doctors can make mistakes.

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