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Kaleidoscope of the Heart: Doctors need to remember how it feels to be a patient

Rika Kayama (Mainichi)

People undergoing treatment for depression or other psychiatric conditions can also develop physical ailments. Sometimes it's something that will get better relatively quickly, like influenza or gastroenteritis, but other times it's cancer or another condition requiring surgery. When a patient in this situation asks me, "Doctor, what should I do," I tend to blurt out, "It'll be fine. We will get you the treatment you need right away."

When talking to a friend, they are likely to respond to this encouragement with a positive "Yeah, I'll do my best." But my patients are often already be dealing with psychiatric symptoms like anxiety or insomnia. If I just tell them to do their best, they can sometimes be left with the impression that I don't truly understand their worries, and may end up feeling even worse. When I see a patient's shoulders slump with disappointment at my words, it snaps me back. I tell them, "I'm sorry. I know thinking of tests and surgery can make us feel helpless," and then with a fresh mind, I ask them to tell me about their worries again.

I imagine there are people without depression who have had the same feelings. For example, when a medical doctor discovers early-stage stomach or breast cancer, this is nothing new to them. I suspect that doctors often tell patients right there and then when they find a tumor during an examination, and say things like, "These cases can almost always be successfully treated with surgery."

But for the patient, being diagnosed with cancer and told they need surgery may both be entirely new experiences. Also, the words "almost always successfully treated" may stick in their mind, leading them to dwell on the negative part: that sometimes, it can't be treated successfully. These kinds of things must surely happen to people.

We doctors are professionals, so we are used to what goes on in medical settings. But the people who come to us are not. I tell myself that I cannot forget this mismatch.

When I'm at a hospital to see patients, the reception staff sometimes tell me they see a patient looking terribly sad after a doctor has abruptly and breezily told them, "You'll need surgery," or, "You need to be admitted to hospital."

Perhaps something more like, "Yes, yes, I understand. Anyone would be shocked when suddenly being told they needed surgery. In fact, my mother had the same procedure. She was worried, but she recovered remarkably quickly, and is living a healthy life now. So I think maybe you don't need to be so anxious," would be better.

It is perfectly natural to be worried when you get sick. Even setting aside illnesses, there are a lot of things to worry about or fret over in the course of one's life. Of course, professionals are needed for treatment, but having someone who will stick with you and share your feelings might be even more important. It has been a long time since I became a doctor, but I still have many things to learn.

(By Rika Kayama, psychiatrist)

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