Physician as Patient
Katherine Keech, MD and Leelach Rothschild, MD
Article
Castro-Frenzel F. Physician-as-Patient—Vulnerabilities and Strengths. JAMA. 2022 Dec 20;328(23):2303-2304. doi: 10.1001/jama.2022.21859. PMID: 36538307.
To our pediatric anesthesia community of friends, we hope you never face circumstances like those of Dr. Karla Castro-Frenzel when she received her life-altering diagnosis four years ago. However, the reality is that some or really many of us will inevitably encounter such news during our careers, given the statistics and nature of our work.
Both of us (KK and LR) have navigated our own cancer diagnoses, and we understand the unique challenges of being both a physician and a patient. In Dr. Karla Castro-Frenzel’s reflection, Physician-as-Patient–Vulnerabilities and Strengths, she poignantly recounts her experience upon receiving her diagnosis. With the benefit of time and reflection, she shares the lessons learned on her continued journey. Today’s PAAD explores Dr. Castro-Frenzel’s reflections and the adversarial roles we might adopt during treatment, grappling with emotions like certitude, shame, guilt, and isolation. Yet, it also highlights the strengths inherent in the dual role of physician-as-patient, reminding us of the need to draw on our inner strength and cling on to hope. We thank Dr. K Castro-Frenzel for being open, vulnerable, and reflective and for sharing your wisdom!
Dr. Castro-Frenzel's experience underscores the unique position of physicians who become patients and highlights our strengths. One strength lies in our medical knowledge and access to healthcare, which are both powerful assets when navigating our own treatment. She emphasizes that our resilience, “high-intelligence, and working knowledge of the medical system” may benefit our dual role of physician-as-patient. Familiarity with the medical system not only serves us well, not only in our healing journey, but also in our continued service to others in our practice of medicine.
Furthermore, our physician-as-patient experience enriches our ability to empathize with patients. We may gain insights that can improve the care we provide, both to our physician-as-patient colleagues (or their family members), and to our pediatric anesthesia patients. My (LR) own journey with cancer has granted me a deeper understanding of the patient experience and provided me with a bit of a super-power which I now consider to be one of my cancer treatment’s “silver lining”. I now know what it is like to be on the other side, from first-hand experience…with both the good and the bad and am poised to make a unique difference in our patients’ lives.
However, being a physician-patient also comes with its vulnerabilities. As Dr. Paul Kalanithi noted in When Breath Becomes Air, “while being trained as a physician and scientist had helped me process the data and accept the limits of what that data could reveal about my progress, it didn’t help me as a patient.”1 We may struggle with certitude, incorrectly believing we understand our prognosis despite our expertise in a different medical specialty, or experience shame and guilt, wondering if our actions contributed to our condition. Pressures of continuing to work while ill, due to fears of judgment, ill-perceptions of our character or strength, and concern over any additional work-load burden placed on our colleagues, can exacerbate these feelings, particularly in the context of post-COVID staffing shortages. Furthermore, when we struggle to connect to others, and to other physicians, we are prone to feelings of isolation. This experience of isolation can lead to mental health risks, compounding our already elevated risk of suicide as physicians.2 When we experience emotionally vulnerability and isolation, we may continue to work despite the pain, fatigue and overwhelming need to rest and care for ourselves. Both of us (KK and LR) felt the need to step-back from clinical care not only during the initial stages of our diagnosis which were filled with tremendous stress, uncertainty, and many 1st, 2nd and 3rd opinions, but also critically important during our convalescence and rehabilitation post-treatment. As physicians we may have bought into the art of healing and the strong desire to “restore health”, yet we haven't quite figured out how to experience illness or build working communities that support colleagues experiencing illness.
Despite all the difficulties posed when we assume the patient role, Castro-Frenzel notes that we continue to save lives and contribute to our medical community. Harnessing our strengths as physician-patients can enable us to make meaningful contributions to both our profession and our personal well-being as we learn to grapple with our physician-as-patient journey. We have the medical foundation to join advisory boards or medical committees and provide medical expertise to help support individuals in the community with similar diagnoses.
Aligned with our process improvement approach in medicine, we owe it to each other to do better (for each other) and to build supportive work environments that promote well-being and minimize burnout3,4; we should strive to create system-level changes that care about our needs and those of our colleagues suffering silently in the face of new medical diagnoses. Strength lies in our networks and connections. By opening to our colleagues, we may receive invaluable support—faith, hope, and love—from our peers.
We (KK, LR, and CK-F) have witnessed firsthand the strength of the SPA community. With support from SPA’s Well-Being Committee—especially Drs. Rebecca Margolis and Norah Janosy—we launched H2O: Healers Helping Each Other https://pedsanesthesia.org/wp-content/uploads/2024/10/SPA-H2O-One-Pager-Final.pdf and on a play on words courageous we call this: Cure-Ageous H20, an initiative to support pediatric anesthesiologists confronting the challenges of a new cancer diagnosis. We (KK and LR) hope this group empowers SPA members to recognize their strengths and provides essential support. Please visit our table at the upcoming SPA annual meeting in Orlando. By opening our hearts to our colleagues, we may "receive the ultimate gift from our fellow partners in healing: faith, hope, and love." Our collaboration has already built lasting friendships, and we are eager to share this journey with you.
For more information about Cure-Ageous H20 and the motivations behind its creation, please visit the SPA One-Pager website https://pedsanesthesia.org/wp-content/uploads/2024/10/SPA-H2O-One-Pager-Final.pdf.
Send your thoughts and comments to Myron who will post in a Friday reader response.
PS from Myron: At least a third of the PAADs readers live and practice outside of the U.S. and many more who do live in the U.S. may not be members of SPA. This is an important initiative not just for SPA members but for all of you as well. Setting up a Healers Helping Each Other program in your own countries, communities or practices is something that you should strongly consider. Drs. Rebecca Margolis, Norah Janosy, Katherine Keech, Leelach Rothschild, and Karla Castro-Frenzel would be invaluable resources in helping you do this. And in the immortal words of Hillel the Elder, a prominent Jewish scholar from the first century BCE: "If not now, then when?"
PSS from Myron: For those of you attending the SPA annual meeting, the SPA’s wellness group will be hosting a walk-run at the meetig: it is an all-inclusive, all ages, all abilities welcome, opportunity to socialize and get some much needed exercise along the scenic golf course just before the last day of the conference. And it's completely free, but people need to register.
Here's the link for registration: https://www2.pedsanesthesia.org/forms/registration/2025winter_register.iphtml
Best,
REFERENCES
1. Kalanithi P. When breath becomes air. Thorndike Press large print edition. ed. Thorndike Press large print popular and narrative nonfiction. Thorndike Press, a part of Gale, Cengage Learning; 2016:241 pages.
2. Plunkett E, Costello A, Yentis SM, Hawton K. Suicide in anaesthetists: a systematic review. Anaesthesia. Oct 2021;76(10):1392-1403. doi:10.1111/anae.15514
3. Afonso AM, Cadwell JB, Staffa SJ, Sinskey JL, Vinson AE. U.S. Attending Anesthesiologist Burnout in the Postpandemic Era. Anesthesiology. Jan 1 2024;140(1):38-51. doi:10.1097/ALN.0000000000004784
4. Afonso AM, Cadwell JB, Staffa SJ, Zurakowski D, Vinson AE. Burnout Rate and Risk Factors among Anesthesiologists in the United States. Anesthesiology. May 1 2021;134(5):683-696. doi:10.1097/ALN.0000000000003722