Elsevier

EXPLORE

Volume 16, Issue 3, May–June 2020, Pages 145-151
EXPLORE

Review Article
Doctors’ experience of becoming patients and its influence on their medical practice: A literature review

https://doi.org/10.1016/j.explore.2019.10.007Get rights and content

Highlights

  • When doctors become patients, they experience drastic life changes.

  • Some noted the difficulty in being a patient with a pervasive identity as a doctor.

  • Others likened doctors to wounded healers who gained insight from their experiences.

  • Previous studies lacked an analysis of doctors' contexts and biomedical viewpoints.

  • Further research addressing and integrating this lacking analysis is recommended.

Abstract

Purpose

Doctors’ illness experiences can deeply influence not only their perceptions of illness and roles but also their medical practice. Researchers and doctors have sought to understand what happens when doctors become patients. However, currently, literature reviews focused exclusively on their illness experiences are lacking.

This review examines academic literature and combines it with illness narratives (i.e., pathographies) written by doctors to elucidate the unknown about doctors’ experiences and its subsequent influence on medical practice.

Methods

An electronic search of the databases Academic Search Complete, Google Scholar, PubMed, ProQuest, and Ichushi-Web was conducted using relevant keywords. The literature reviewed included studies that described doctors’ illness experiences or doctors’ perspectives on their experiences of being patients.

Results

Previous studies showed that doctors’ disease prognoses are generally better than or similar to those of patients belonging to the general population. However, doctors’ documented illness experiences are multi-dimensional and have several common themes. These include the concept of the ‘medical self’ (behaving as a doctor despite being a patient) and ‘role reversal’ (the doctor adjusting to the patient role). The other elements of their experiences include barriers to health care, self-treatment and self-doctoring, presenteeism, and ‘wounded healers’ (those who can heal others using the wisdom from their illness experiences). Most previous literature has omitted the sociocultural and historical dispositions of doctors and their biomedical perspectives of their own afflictions, even though these strongly impact their illness experiences.

Conclusion

Further research that re-contextualises the meaning of illness for doctors is necessary.

Introduction

That doctors should always be healthy is an age-old premise in Western medicine.23,30,48,50,79,87 This idea possibly originates from a quote in the Corpus Hippocraticum (as edited in the Roman era) that ‘Doctors should look healthy’.45 A quote based on the same premise, ‘Isha no Fuyojoh’, which literally means ‘Doctors do not care about their health’ appeared in a Japanese book written in the 18th century and was coined to tease a doctor who fell sick. This quote has been widely used since then and continues to be frequently heard in Japan when doctors fall sick. Therefore, doctors have long been expected to remain healthy. Doctors also take it for granted that they would always be healthy. Ironically, many of them appear to not care about their health.15,91 Kay et al.53 reported that medical students and doctors are seldom taught how to deal with their own illnesses throughout their medical education and training. However, owing to recent concerns about the psychological, social, and physical well-being of medical students and doctors,15,55,81,93,97 the influence of the educational environment on learners’ wellness has been investigated and interventions geared toward improving students’ and doctors’ well-being have been implemented by medical schools93 and training hospitals.20,94 Therefore, it can be said that doctors, medical educators, and educational institutions have begun to seriously tackle issues related to doctors’ health and well-being.

Another well-known but contradictory idea persists that doctors should become patients at least once to be able to understand their patients.67,73 This alludes to the notion that without experiencing patienthood, doctors cannot truly understand what it means to be ill, despite seeing patients almost every day. Thus, this idea suggests that there is a disconnect between the doctor and patient until the doctor falls ill.

These themes have long garnered the interest of doctors and researchers. In his book, Sickness and Healing: An Anthropological Perspective, the American epidemiologist and anthropologist Robert Hahn points out that ‘the written accounts in the genre of doctors’ illnesses had been seen for over thirty years.40 (p. 235). In 2018, there are far more illness narratives written by doctors and researchers than in the past, along with guidelines and guidebooks for when doctors become ill. Nevertheless, as there are no literature reviews on the illness experiences of doctors and how these experiences influence doctors’ medical practice, it is difficult to determine how to further explore this topic.

We reviewed the existing literature on doctors’ illness experiences to deepen our understanding of how these experiences influence doctors’ medical practice. We also reviewed illness narratives (both articles and pathographies) by doctors and compared them with academic studies. These reviews lead us to highlighting the necessity of further research on doctors’ experiences as patients and how these experiences influence their medical practice.

Section snippets

Search strategy

We reviewed literature published until 2017 on the electronic databases Academic Search Complete, Google Scholar, PubMed, ProQuest and Ichushi-Web (an electronic database for Japanese medical journals); although owing to its own limitations, the first database, only included papers published between 1961 and 2016. The keywords used were ‘doctors become patients’ and ‘doctors as patients’ for Google Scholar and ‘doctors become patients’ and ‘physicians become patients’ for Academic Search

Results

In the first section of the results, we review the academic studies of doctors’ illness experiences. In the second section, we review the illness narratives to enrich our understanding of the academic studies. By combining a study of narratives with that of formal studies, a deeper understanding of physicians’ illness experiences is expected.

Discussion

The existing literature illustrates how doctors’ afflictions result in them changing their perspectives about themselves and others through their experiences of becoming patients. Academic literature has explored these issues qualitatively and quantitatively, not only in the field of medicine but in other fields too, such as sociology and anthropology. Doctors’ experiences as patients differ from those of the general public because they navigate between their medical selves, role reversals and

Acknowledgments

We wish to thank the graduate students and the faculty of the Medical Education Center, Kyoto University Graduate School of Medicine, for the fruitful discussions on this article. We also thank Prof. Kazuhiro Kazama, Assoc. Prof. Ayako Iwatani, Asst. Prof. Gaku Kajimaru, and their students at the Graduate School of Human and Environmental Studies, Kyoto University. They gave us substantial comments and helped us to revise the draft. My thanks also go to Assoc. Prof. Mario Ivan Lopez, Center for

Declaration of Competing Interest

The authors declare no potential conflicts of interest with respect to the research, authorship or publication of this paper.

Funding

This research did not receive any grant from funding agencies in the public, commercial or non-profit sectors.

Mariko Morishita is a Ph.D. student and teaching assistant at the Medical Education Centre at the Graduate School of Medicine, Kyoto University, where she studies medical education and medical anthropology. Her research interests include doctors’ experiences with becoming patients, doctors’ wellbeing, and undergraduate primary care education.

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    Mariko Morishita is a Ph.D. student and teaching assistant at the Medical Education Centre at the Graduate School of Medicine, Kyoto University, where she studies medical education and medical anthropology. Her research interests include doctors’ experiences with becoming patients, doctors’ wellbeing, and undergraduate primary care education.

    Junko Iida is a professor of anthropology at the Comprehensive Education Centre (Faculty of Health and Welfare), Kawasaki University of Medical Welfare, Japan. Her research interests include Thai traditional medicine, local healing practices in northern Thailand, palliative care in Japan, and anthropology education for (future) health professionals.

    Hiroshi Nishigori is a professor in the Centre for Medical Education, Graduate School of Medicine, Nagoya University and is the Visiting Project Leader professor in the Medical Education Centre at the Graduate School of Medicine, Kyoto University. His research interests include medical professionalism, medical education within the humanities, and virtue ethics in medical education.

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