Physician, heal thyself is the English translation of the ancient Latin proverb quoted in the title. Various forms of this quote are found in a variety of classical texts, and it is generally accepted that the saying refers to the hypocrisy of offering advice to fix the defects of others without first attending to one’s own shortcomings. Interestingly this proverb takes on additional meaning for healthcare providers since it is generally accepted that providers should not medically treat themselves or family members, in most cases. The American Medical Association (AMA) Code of Medical Ethics opinion 1.2.1 outlines explicitly the negative consequences of caring for oneself or a family member and states “physicians should not treat themselves or members of their own families.”
I imagine most providers reading this column, like myself, have treated themselves or family members for minor issues and for convenience. The AMA, in its own statement on this issue, recognizes this reality and exception to their own policy by noting physicians will treat themselves and family in emergencies and for minor, short-term problems. Although providers acting in emergencies when no other qualified provider is available seems intuitive, the line of when to seek medical assistance for self or family seems far less defined and challenging to determine.
Personally, when it comes to medicine, I find it far better to “give than receive.” I have absolutely no aversion to inflicting medical advice on others, but I have an intense, borderline irrational, distaste for receiving medical services. My trips to the dentist for routine care are perhaps most emblematic of my baseless aversion for medical care directed at my person. Even a basic cleaning will ruin my day if it appears on my schedule.
Because I am such a bad patient, I have worked throughout my life to limit opportunities for becoming one. It is not an exaggeration to say that the only times I willingly went to the doctor as an adult was when I was inducted into the Army and when I processed out. Fortunately, my health has generally been good. I have avoided broken bones or need for surgery, and my illnesses throughout the years were minor enough to support my healthcare system avoidance foolishness.
Admittedly, during my Army, avoiding any medical opinion other than my own to impact upon my health was a point of personal pride that I have even boasted about. I do not feel my attitudes as a physician are necessarily novel in this regard, and I would bet that many of you reading this column can even identify with my admission and are likely practicing a similar aversion to seeking medical advice outside of your own counsel. While I can certainly commiserate with these attitudes as this editorial testifies, I have come to understand the foolishness and absurdity of this practice.
For the second time in 18 months, I have developed right-sided pneumonia for no discernible reason — which has taxed my constitution and severely limited my activity. My first bought of pneumonia I erroneously thought was related to my gallbladder since the pain was focused in my right upper abdominal quadrant. A motivating wife, a trip to the emergency room the following morning, an astute primary care doctor, and a CT scan of my lungs revealed the consolidation over my right diaphragm and the actual diagnosis. More recently, I misdiagnosed a frontal headache and chronic cough as sinusitis that I self-treated with azithromycin. When the cough persisted, I finally contacted my primary care physician and the ensuing x-ray revealed the right middle lobe consolidation.
Fact is I have had respiratory issues ever since deployments to Iraq and Afghanistan. Living next to the Camp Anaconda burn pits in Iraq was not a respiratory picnic for anyone there at the time. My wife insists my snoring and sleep apnea symptoms began after that deployment. Are these cases of pneumonia and those deployments related? I have no idea, but I certainly am in no position to answer these questions myself. I am now on the second course of antibiotics, I am feeling better, and I am armed with a pulmonology consult. I cannot help but wonder if my self- imposed moratorium on routine health visits might have avoided or at least mitigated my abysmal handling of both pneumonia episodes.
I have used this forum to relate this bit of personal hubris and foolishness concerning healthcare for myself as a warning to those like-minded individuals who continue the ridiculous practice of “Medice, cura te ipsum.” As providers we know we lack the objectivity, detachment, and in many cases knowledge (do not ask an anesthesiologist how to treat pneumonia) to care for ourselves or family. I now realize my prideful years of avoiding the doctor were ill-advised, and I was fortunate to get away with it (fools and drunks). I am convinced now that part of being a good doctor is the simple practice of being a good patient. I will strive to be that good patient in the future, I recommend you do the same for the sake of your patients and yourself.
“13. The delivery of good medical care is to do as much nothing as possible.” “Laws of the House of God,” —Samuel Shem
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