Portland, Ore.

Report printed in this week's edition of The Journal of the American Medical Association .

Physicians at Oregon Health & Science University and Harvard Medical School have published guidelines for physicians who provide end-of-life care to other physicians. The article discusses the care of one particular dying physician from the perspectives of his treating physicians and his son (who is also a physician). The authors offer suggestions for dealing with the unique relationships that develop between physician-patients and their treating physicians. The findings are published in this week's edition of The Journal of the American Medical Association (JAMA).

"While this paper details the particular circumstances where a doctor becomes a patient, we hope some of the lessons will help physicians better care for patients in general," said lead author Erik Fromme, M.D., an assistant professor in the Division of General Internal Medicine and Geriatrics at OHSU, who co-authored the article with Harvard's J. Andrew Billings M.D. "By seeing health care through the eyes of a patient, physicians learn lessons that can benefit all physicians hoping to improve their bedside manner. These cases offer a unique opportunity to deepen one's understanding of the patient's experience."

The article includes case-study interviews with the treating physicians and physician-son involved in the care of a physician-patient who suffered from heart disease and a blood disorder. Challenges that surfaced throughout the physician-patient's care included: the difficulty of treating patients who are also colleagues, the reluctance some physicians have in assuming the role of patient, and the physician-son's struggle to be both son and doctor to his dying father while simultaneously trying to grieve his loss.

"One commonly noted reaction of a physician-patient is their reluctance to deal with, or talk about their own health," added Fromme. "As physicians, we're trained to set our own feelings aside and focus on our patients. That habit may be hard to let go when we become patients ourselves, making it hard for us to allow ourselves to be cared for."

The JAMA article also includes many suggestions for negotiating a healthier relationship between the physician-patient and the treating physician. These guidelines include conversations about confidentiality issues that may arise when patients are treated in their own hospital by colleagues. Another guideline offers suggestions for dealing with physicians interested in taking a more active role in their own care in the form of self-prescribing and other activities.

Fromme hopes to learn more about how physicians learn from their experiences as patients through another unique study currently under way. He is surveying a larger group of physician-patients to determine how their own experiences as patients affect the way they practice medicine. "When doctors become patients there is a chance to learn volumes about improving patient care and communication," he said.