DOCTORS aren’t supposed to have favourite patients. We are not supposed to feel anything, really. We are supposed to be objective, dispassionate, and to not favour anyone over any other, for we are to have no feelings for any of them. No matter who they are, what they are going through, how they are behaving, how much we relate to them, or how much they inspire us. For we are scientists, and medicine is a serious business.

I tried to live like that once, and ended up in a rehab centre at a young age.

So, now I just live my life as a human being, who practises the art and craft of medicine, and loves it.

I now work in a small country town, and live nearby, and have been caring for some of my patients for up to 20 years. I also see them down the street, at the markets, on the beach, and I have a relationship with them, as a doctor, and as a person.

I see myself as having a relationship with all of my patients, and some of these relationships are closer than others, just as we have many friends and acquaintances but there are some we feel particularly close to. And as with all my relationships, I learn a great deal from my patients, about medicine, about people, and about life.

Going blind is not the end of the world

One of my patients is in her 90s, and when I inherited her from another doctor who had retired, she was already blind from macular degeneration. It was the dry, wear-and-tear, just-old-age kind, so there was nothing we could have done about it, even now. It came on relatively quickly, after her husband died. Her vision is only count fingers in each eye, but this does not seem to stop her from doing much. Despite her disability, she still cares for herself, writes letters, gets people to help her read the replies and listens to talking books, but mainly spends time connecting with and engaging people in conversation.

She comes to see me with her daughter, to say hello and to have her eyes checked for other treatable diseases like glaucoma. We all love these visits. We laugh and joke and just have fun together. We both know there is nothing I can do for her in a physical sense, apart from these checks, but that does not mean I shut down to her as a person.

She is not fazed by her blindness, has accepted it, and makes the most of life in spite of it.

She is not fazed by her age, is mentally as sharp as a tack, and is as joyful as she was when a young girl.

She has taught me that it is not the end of the world to go blind (which is something I was terrified of when I was younger, and quite possibly the real reason I became an eye doctor), and it is not the end of the world to grow old.

She has taught me that it is okay to just love my patients, and to say “I love you” to each other, as we would to any other old friend.

She has taught me that even if I cannot “do” anything for my patients, that just being me with them is enough; that just being myself can be healing for them, and for me.

Having a hard life does not have to make you hard

I have another favourite patient who comes to see me for regular checks. I took his cataracts out several years ago. He is a Vietnam veteran who has been through horrors that we can only imagine, and yet he has the sunniest outlook on life, and is a big, jolly, giant-hearted man. The only sign of residual hardness is that when he gives you a hug, or shakes your hand, you feel like he may just crush the life out of you!

I have many patients whom I love dearly. Children whose squints I have operated on who have now grown tall and look me straight in the eye; people whose cataracts I have removed and who delight in being able to see clearly again (except for seeing their now obvious wrinkles); people whose glaucoma I tend to and check on regularly so that their vision is preserved for life and whose 6-monthly visits are a marker in both of our lives of the passing of time; people who gracefully submit to injections for macular degeneration, knowing that they would not be able to see without them; people who just come to see me for eye health checks and their appointments roll around with clockwork regularity and we both say we cannot believe that another year has passed already and delight in sharing stories of what the year has been for us.

My favourite patient of all

But perhaps my favourite patient of all is me. I have learned so much from being a patient – how to be a better patient, how to be a better doctor, and how to be a better person.

I have mainly learned the hard way – not seeking help when I was struggling with depression and alcohol addiction during my training, so that I had to get really sick before I was willing to submit to rehab; not seeking help after the birth of my second child when I developed an ovarian abscess due to undiagnosed pelvic inflammatory disease and let it go undiagnosed and untreated until I had to have emergency surgery for a suspected ovarian tumour; not resting after the surgery and lifting my small kids too soon and stretching the scar on my belly; seeking help when I found a lump in my leg and having a cold node removed, but not resting afterwards, going back to work and re-bleeding, causing a huge secondary haematoma that had me on the couch for far longer than I would have spent there had I heeded my surgeon’s sensible advice; not taking time off when I had to have 3 weeks’ radiotherapy when the lymphoma recurred (I had refused it the first time), but going in for treatment early in the morning, then driving to work for the day. I finally relented and let my husband come with me for the last treatment, and when I felt what I had been doing to myself, collapsed in a blubbering heap, from which I had to recover to operate that afternoon.

These life experiences have taught me that doctors in general (or perhaps just me in particular) make pretty terrible patients. We think we know better, we do not follow the rules, we do not grant ourselves the time and space needed to care for ourselves, to heal after surgery, to rest when we are ill. We expect ourselves to be superhuman, and think that the world will stop turning if we take time off to recover from illness and surgery.

But along the way I have also learned to be humble, to be compassionate, to no longer try to self-diagnose but to seek help, to have a GP I trust who knows me well and whom I see regularly for check-ups, to follow instructions when I am given them, and to understand why people don’t, which makes me much more able to sniff out people who are going to flaunt the rules in my own practice and gently set them straight.

I have learned that illness is not a punishment but is often a consequence of us choosing to live in a certain way, and that we therefore have the power to care for ourselves in a way that can recover our health and keep us well to a large degree.

And since I have learned these humbling life lessons, I rarely get a cold, let alone a serious illness. I work hard but give myself time off to play, I care for myself deeply, I rest when I am tired, I eat and drink in a way which nourishes my body, and I make time and space for my partner, my children, our large family and our friends. I love my life and I love being a doctor who has also learned to be a great patient.

Dr Anne Malatt is an ophthalmologist who works in Bangalow, northern NSW.

 

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7 thoughts on “How my patients taught me to be a better doctor and patient

  1. Anonymous says:

    As a young doctor in training, struggling to treat myself with kindness, I found your piece inspiring and warming. Thanks for being one of the chinks of light in the tunnel.

  2. Anonymous says:

    Thanks for having the beautiful vulnerability to share your story, it is much appreciated!

  3. Andrew Nielsen says:

    Re: “We are not supposed to feel anything, really. We are supposed to be objective, dispassionate, and to not favour anyone over any other, for we are to have no feelings for any of them.” That was not true, never has been and never will be.

    Google Massachusetts general hospital psychiatry. Go to the Google Book and go the page 17 of the 6th edition.

    No feelings = no therapeutic relationship. As patients are people, if you are not aware of you feelings, will do crazy things.

  4. Anonymous says:

    As a GP I love being a patient. It reminds me of the incredible trust that patients have in us their doctor to treat them. Makes me a better doctor.

  5. Frank New says:

    DOCTORS aren’t supposed to have favourite patients. We are not supposed to feel anything, really. We are supposed to be objective, dispassionate, and to not favour anyone over any other, for we are to have no feelings for any of them. No matter who they are, what they are going through, how they are behaving, how much we relate to them, or how much they inspire us. For we are scientists, and medicine is a serious business.

    Dear oh dear. Someone has not had good quality training. That was certainly not my training.
    We are supposed to be aware of the feelings we have, and to control how we respond to these, being wary to not disadvantage the patient because of reactions which are more related to our personal circumstances than to the patient’s conditions.
    Sometimes this may not be possible, at last in the short term eg following a bereavement for the practitioner, or a practitioners ‘critical incident’
    In this case it is appropriate for the practitioner to seek assistance, perhaps to help the patient, perhaps to help the practitioner.
    Sometimes it is appropriate to alter some aspects of practice until the interests of the patient can be managed without the practitioners personal reactions interfere unnecessarily Practitioners will inevitably have responses to their patients, as a normal person, which they should be aware of, and manage well. They can be useful.

  6. Anne Malatt says:

    Hi everyone,
    it is most interesting to read the comments here and to notice that the tender appreciative ones are made by people who feel they need to remain anonymous, but those who are being critical feel fine about being public. I wonder what this says about us as doctors? Do we not feel safe to be open, honest and vulnerable with each other in the medical culture?

    Andrew, if pigeonholing people with the DSM were the answer to all our woes, medicine, and our society, would not be in the mess we are in. Of course we have feelings, but certainly when I was training we were expected to override these. Perhaps times have changed, but I teach medical students from several universities, and it would appear that if anything, things have gotten worse and they are under even more pressure than we were to perform, at their own expense, with no regard for their own needs or feelings.

    Frank: “Dear oh dear. Someone has not had good quality training.” This is patronising and belittling of me and my personal experience. This is an opinion piece, and I, as are you, have every right to express my opinion. You don’t have to agree with it, but putting me down personally is not ok. I hope you treat your patients with more care and consideration than this when they come to you with their personal experiences.

    And just for the record, while my training was technicallly excellent, I was subject to similar patronising, belittling, discrimination and outright sexual abuse during my training, so no, I would not say it was of “good quality”. And I would like to think that this has changed over the years, but I know that it hasn’t, and comments such as this show that these attitudes still prevail.

    I have gone from being a stressed, anxious, depressed, burnt out, alcoholic insomniac as a young doctor to someone who is happy, healthy and loves her life and work. All without the help of the DSM, CBT, medication or shock therapy. And I am very in touch with my own feelings and those of my patients, and very aware of the effect of how I am as a person and how I live my life on my practice of medicine. Perhaps an open curiosity as to how and why I have been able to do this would serve us all more than a patronising putdown.

    I love a debate as much as any other, but let’s keep it light and not resort to personal slights.

  7. Anne Malatt says:

    Hello again, Andrew, I took up your suggestion and googled the Mass General Handbook of Psychiatry. Thanks for the reference, I appreciate it. I would like to point out though, that this is a psychiatry text and my general medical and surgical training offered no such advice. If others have a different experience, that is great and would be reassuring.
    I am intrigued by the complexity of psychiatric concepts and language. Why do we not just go with the simplicity of human care and connection? In and from this space, we can better observe and understand ourselves, and others, have compassion for all, and rather than react to what is before us, respond in a loving, caring way.
    When I saw a psychiatrist for a short time during my stint in rehab, he had the grace to admit he had nothing to offer me, but his genuine care and concern was very healing…perhaps this is all that is needed.
    It seems much simpler to me, but perhaps I am just a simple surgeon…

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