Three things you need to know when your patient is a doctor

When your patient is a fellow physician, the rulebook might have to go out of the window; assumptions on both sides can get in the way. But both physicians can stand to gain from this relationship.

One minute, you may be working with a colleague to care for a critically ill patient in the hospital. But in the next minute, this same colleague could be in your waiting room.

What is more, they may be seeking your advice on a sensitive medical issue, such as a sexually transmitted infection or prostate cancer.

Providing care to other physicians has its own unique set of challenges that extend beyond those encountered when caring for patients that you might know at a personal level.

These intertwined relationships can be hard to navigate; they have the potential to create an awkward, anxiety-provoking environment for many physicians.

In a study in Family Medicine, Amy Domeyer-Klenske, M.D., and colleagues reported how physicians most commonly deal with the challenges of caring for physician-patients.

According to Dr. Domeyer-Klenske, treating the physician-patient the same as any other patient is key. This can be done by ignoring their background, acknowledging their background up front and negotiating a treatment plan that both physicians can agree with, or allowing the physician-patient to determine their own healthcare plan.

What are some assumptions about your colleagues that can affect how you care for them? Medical News Today spoke to some experienced physicians to find out how they work through these potentially complicated relationships.

How assumptions can affect care

Dr. Domeyer-Klenske found three common areas that were consistently listed as causing the most difficulty when caring for their fellow physicians:

  • assumptions about patient knowledge and the health choices they make
  • medical care driven by the physician-patient
  • boundaries between relationships with colleagues, or between roles as physician/colleague/friend

It is not uncommon for physicians to assume that their physician-patient knows more about their diagnosis or treatment than they really do.

Because of this, physicians are more likely to assume that their physician-patients are completing all of the recommended follow-up appointments and monitoring their symptoms at home.

They also assume that their peers are making the right lifestyle and behavior choices, which isn't always true.

Courtney Younglove, M.D. - medical director of the Kansas Weight Loss and Wellness Center in Overland Park - felt that the level of medical care she provides is the same whether the patient is a physician or not.

"I treat the physicians I see similarly to my non-physician patients but I probably do explain things a little bit less," Dr. Younglove told MNT. She did acknowledge that this assumption might not be accurate, but she also felt that most physicians are already pretty knowledgeable and don't need to be re-educated about basic medical concepts.

This opinion was shared by Alka Mittal, M.D., a gastroenterologist in Shawnee, KS. "I am more inclined to provide my physician-patients with the primary medical literature than to discuss the basics of their problem," she said.

But making assumptions can create problems when caring for physician-patients.

Physicians surveyed by Dr. Domeyer-Klenske reported that the level of care they provided their peers differed from their non-physician patients.

Some assumed that their fellow physicians would automatically tell them all of the important information they needed to accurately care for them. These physicians tended to ask fewer questions and avoided asking about sensitive issues, leading to reduced or incomplete care.

Others felt that their peers had a higher expectation of them than their other patients. It felt as if they were being evaluated on their performance as a physician. This caused them to perform more thorough examinations and evaluations than necessary, leading to too much care.

In order to avoid the problems associated with either approach, physicians need to strive to provide appropriately managed healthcare to all of their patients, whether they are physicians or not.

One question worth asking is, "Can involving physicians in their own care help?"

Care driven by the physician-patient

Physician-patients naturally have access to more medical information and knowledge than other patients. While this is often a good thing, it can also be challenging for both the physician and the physician-patient to incorporate this knowledge into patient care.

Conflicting opinions about the best approach to care can lead to frustrations on both parts.

Whether you take your patient's opinion into consideration but ultimately make the call, or you allow them to make the majority of decisions, open communication is key to agreeing on the level of involvement of the physician-patient in their own care.

"I come up with things that I think are going on and things that I think might be the answer. I then listen to what the other physician has to say and see what their opinion is. But ultimately, it is my body and I have to decide what I want to do."

Alka Mittal, M.D.

Dr. Mittal purposely chooses physicians that she regards highly and that she knows are unlikely to dismiss her knowledge.

As with all medical care, shared decision making is important. So it makes sense to include patient-physicians' knowledge into directing their own medical care. The challenge is finding the right balance.

But what can you do if you run into problems? According to Dr. Younglove, "Approaching a challenging physician-patient is best done by being direct and honest." She finds that when she does address problems directly, most physicians respect this approach and respond well to it.

Boundaries can become blurred

When caring for non-physician patients, the roles of the physician and patient are generally pretty clear. But caring for a fellow physician, who may have just as much medical knowledge or more about their illness, often creates situations in which these roles may be less defined.

For the most part, physicians can create comfortable, well-working relationships with their peers.

Dr. Younglove did not see problems with boundaries in her practice. Generally, "when a physician comes to see me they are looking for my opinion. They tend to be pretty good patients."

But some physicians do have trouble separating their role as fellow physicians, and possibly friends, from that of a patient. They may find that it is awkward or uncomfortable to see their colleagues as patients and to discuss sensitive personal information with them.

Once they do know more personal information about a fellow physician, it can make it harder to work together.

One strategy to try is to "de-doctor" your physician-patient, as described in Dr. Domeyer-Klenske's study. This means dispensing with any assumptions that you have about them professionally, and treating them the same as all of your other patients.

Every physician will need to find their own strategy for caring for their fellow physicians. Over time, these strategies are likely to change as they gain more experience with treating their colleagues.

Despite these challenges, taking care of other physicians can be a very rewarding experience, and, in many ways, is easier than caring for non-physician patients.