The Physician as Patient: Medicine after COVID-19

Abstract

The Physician as PatientMedicine after COVID-19 Laura Kolbe (bio) when i was a child, four nuns worked in my Catholic grade school and lived in the "convent," a small, plain ranch house on the property. Three taught while one ran the business of the parish. Their short gray curly hair, their coordinating brown clothing, and the appellation "Sister" gave me the confused notion that they were related. This prompted the further extrapolation that all teachers must belong to some vast yet exclusive family, set apart from the rowdy tribe of non-teachers that my own family belonged to. Two of my aunts claimed they were teachers. I didn't believe them; both had houses, and one even went on dates. I think that on some level adults have the same notion of physicians. I certainly do when I'm the patient, even though I am a physician, even though my own primary care doctor is a colleague [End Page 5] whom I've glimpsed attending to the many nonclinical parts of her life on her phone during the duller parts of faculty meetings. There is, you'll be sorry to learn, something called #medtwitter (one part gripes, two parts preachy threads, with a dash of haphazardly edited vacation and postpartum photos), which might initially seem to recontextualize doctors back into the yowling Family of Man but in fact often renders us ever more generic and implausible as individuals. The genre conventions of the format fit our self-expression into a few flat archetypes—the pedantic explainer, the griper, the eternally grateful and blessed—as non-native to true human reality as those classical sculptures of Hippocrates that turn him into a hypertrophied megalith of brawn. But then came COVID-19. Many doctors—along with all kinds of other health care and frontline workers—had the chance to render their idiosyncratic experience on the page and screen, and the public was listening. We each had particular things to be angry and sad about. We watched irreplaceable patients die under our care; we each had our own unique recurring nightmares; our marriages and family structures and friendships were disintegrating, or marvelously holding up, in an explosive variety of particulars for everyone to see. Doctors became people. At my annual visit in 2021, emboldened by the novel thought that my primary care doctor was a person, no more and no less, I told her the truth about how much I drink and how often I exercise—some 80 percent of people are not entirely truthful with their physicians about their health habits, myself very much among them—and the exam table did not collapse in flames. The downside of doctors becoming widely recognized as people is that people are also people, and so now we're on undeniably equal footing: the clinicians and the "everyone else" from whom doctors have long stood carefully apart. In this newly vulnerable moment, my medical uncertainty takes on a different character. Whereas my occasional uncertainty as a doctor once had a numinous sheen, at least to my eye, it is now exposed as the ordinary not-knowing that it always was. (That my not-knowing is often [End Page 6] laced with data and probabilities does not completely change the fundamental head-scratch.) There have always been times when I know that I don't know best, though I also know that my honest counsel is important. It is up to me to tell a patient who wants to leave the hospital prematurely, or decline an important procedure or medication, exactly why I think that's dangerous and imprudent—and then to do my utmost to trust, to teach, and to support if that patient continues to reason otherwise. Within the boundaries of safety and good practice, I take patients at their word about the physical pain they report to me, though that pain is sometimes hard for me to understand or imaginatively inhabit. This becomes complicated when many of the medications that treat pain are also dangerous or potentially addictive, but that very complication means that I need to listen harder, not less. The stakes are too high not to. Even when a patient...