When the doctor is the patient

Robert L. Klitzman, M.D. ’85, expected the grief that followed the death of his sister Karen, who died at the age of 38 in the World Trade Center on September 11, 2001. But he did not expect that he would be unable to sleep and would suffer from persistent flu. Or that he would stop listening to music and take no pleasure in reading.

When friends told Klitzman that he was depressed, he rejected the idea. As a psychiatrist, of course, he knew that emotional depression often manifests itself in the body. “I’d read it in textbooks,” he acknowledged. Eventually Klitzman did recognize that it was depression, not flu, that was making him feel that his body had “given way” beneath him. “Going through it myself made me realize how much I didn’t know about what it was to be a patient,” he said. That realization, he said, was “a defining moment.”

Klitzman, a research scientist and associate professor of clinical psychiatry at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, had already written five books. In fact, he’d gotten his start as a writer by reviewing books while a medical student at Yale—a starting point he recommends to students today. His role models included Richard A. Selzer, M.D., HS ’61; Sherwin B. Nuland, M.D. ’55, HS ’61; and Howard M. Spiro, M.D.—Yale physicians who are also prominent authors. Klitzman had already contemplated writing a book about doctors as patients. Now, however, “It was no longer an academic question.”

When Doctors Become Patients is the product of interviews with 70 physicians of all ages who were facing cancer, heart disease, Huntington disease, bipolar disorder, HIV and other illnesses. Klitzman analyzes such common themes as denial of illness, doctors choosing doctors, “self-doctoring,” going public about one’s disease, overworking, coping and the role of spiritual beliefs.

Klitzman found that the doctors viewed themselves either as patients or as doctors, “as if individuals had a zero-sum identity.” In reality, Klitzman said, “They’re not entirely doctors and they’re not entirely patients.” Klitzman called this “odd hybrid form” the “doctor-patient”—one doctor-patient with a foot infection brought his own bag of opiates to the hospital. And as patients, Klitzman’s interviewees were often upset by the carelessness with which their doctors addressed their fears. A surgeon told one doctor-patient that a procedure carried a 5 percent chance of dying. The patient would rather have heard that he had a 95 percent chance of living.

Just as Klitzman resisted the notion of his own depression, his colleagues also denied that they were sick. They told him, “I feel like I have a magic white coat. Illness happens out there—not to me.” Klitzman noted that magical thinking is part of our everyday lives: “When we blow out the birthday candles, we all make a wish.” But doctors deny their irrationality, contending, “We do not engage in magical thinking. We’re trained scientists.”

Perhaps because doctors see themselves as scientists, they are reluctant to discuss religion or spirituality with their patients, as Klitzman’s research suggests. Yet “when patients are lying in bed, that’s what they’re thinking about,” he said. He advocates adding at least a lecture on the topic during medical school.

A reviewer wrote in the New England Journal of Medicine that Klitzman’s book “goes to the very heart of the question of what a physician is.” In addition, When Doctors Become Patients serves as a lasting memorial to Karen Klitzman.