To the Editor: Recently, I viewed the 1991 film, “The Doctor,” starring William Hurt. Cardiothoracic surgeon, Dr. Jack MacKee, develops throat cancer and experiences what it is like to be a patient. Based on the book, “A Taste of My Own Medicine,” by Dr. Edward Rosenbaum (1), the story is about the physical and emotional toll of illness and the unwelcomed role-reversal of receiving rather than dispensing treatment.

I first saw the movie more than 20 years ago. Although it made a significant impression on me then, it took my own medical condition, something that lacked both the urgency and terror of cancer, to reawaken an interest in this well-done film, which is as relevant today as it was when it was first released.

An L4–5 lumbar disk introduced me to the patient-side of chronic pain. Ten months of intractable sciatic distribution pain, culminating in an inability to sit, eventually required surgery.

In the past, I was prone to conflating patients with chronic pain with their disease. That is, sometimes I thought of patients with chronic pain as “chronic pains.” This was particularly the case when patients required narcotic pain medications. Unfortunately, I don’t think this sentiment is rare among doctors or other healthcare providers. I had recently attended a professional conference on the topic of chronic pain. The speaker started his presentation with the question, “Who enjoys treating patients with chronic pain?” Not one hand went up.

To patients, this bias may seem inscrutable, even heartless. After all, who suffers more, someone with acute pain, where often a diagnosis is readily made, sympathy extended, and effective treatment rendered, or someone who languishes with a murky diagnosis where treatment options are elusive?

Although I was able to function, chronic pain had a corrosive effect on my quality of life, but in a way that was hard to quantify. Certainly, it seemed to defy conventional pain scales. Clueless, I always seemed to select the face in the middle of the continuum, the one with the sloping eyebrows and a straight-line “smile.”

What I do know is that chronic pain made me afraid—afraid of illness, disability, death, and other things, too. I became more vigilant about the potential for accidents and violence. At baseline, I am a protective parent. This condition catapulted me to full-fledged “helicopter” status.

Also, whether through fear or another mechanism, chronic pain made me much less psychologically reflective. As a psychiatrist who has had the privilege of psychoanalysis, my training and experience prepares to think about things from different vantage points, on different levels. During my pain stint, this capacity all but vanished. It was as if my mental energy narrowed in an effort to conserve itself, allowing me to attend only to what was before me.

Finally, chronic pain made me more interpersonally reserved, even distant. Although I’m sure there were times I was curt or irritable, my common reaction was to be more pliant. I agreed to most everything, because I was unable to engage anything deeply.

Like the fictional Dr. MacKee, I resisted being ill and, though outwardly cooperative, I resented being a patient. Also, like Dr. MacKee, I grew professionally and personally from the experience. I know that I don’t view patients with chronic pain the same way anymore. And I know that nothing enhances the relationship with patients more than their doctors and other healthcare givers meeting them where they are—in their fear, their loss, their disappointment.

Within clinical psychiatry, different types of writing exercises have been used to foster learning with medical students and resident physicians. As a requirement, third-year medical students at the University of Texas Southwestern Medical Center write a reflection paper on a topic of their choice drawn from their psychiatry clerkship experience (2). At Massachusetts General Hospital, junior psychiatry residents have used journal writing to comment on an occurrence, impression, dilemma, or countertransference feelings encountered while rotating on emergency psychiatry (3); and at Columbia University, a junior psychiatry resident elected to write imaginative narratives about three patients with severe and persistent mental illness. This exercise increased her empathy for and connection with her patients (4). Outside of psychiatry, within the larger medical profession, personal illness narratives have been used as a teaching tool to cultivate empathy in doctors-in-training (5).

But learning is a life-long process and does not conclude with medical school or residency; and some opportunities for learning do not present until middle- or even late-life. Independent of training requirements, physicians, perhaps especially psychiatrists, of any age, might find that engaging in reflective writing when they become ill can result in greater self-awareness and empathy.