You may have heard that doctors make the worst patients. Whether that’s
true or not is up for debate. But does becoming a patient transform a
physician into a better, more compassionate doctor? That’s the real
question—and one that has been examined over the years. Columbia
University Medical Center psychiatrist Robert Klitzman, MD, explored this
issue in his best-selling book
When Doctors Become Patients. It’s based on Dr. Klitzman’s own time as a patient and interviews
with more than 70 men and women who have experienced both sides of medicine—as
doctors and patients.
Dr. Klitzman discovered that when physicians get sick, they discover cracks
in the health system they never noticed before. Things that may have been
previously deemed unimportant in a patient’s quality of care—such
as a broken television in the waiting room, curt or rude receptionists,
or long wait lines—have a big impact on patient stress. Even those
doctors who considered themselves compassionate realized they could do
better after they experienced life as a patient.
Jerome H. Unatin, MD, agrees wholeheartedly with Dr. Klitzman’s findings. Dr. Unatin,
an orthopedic surgeon who has been in private practice since 1971, became
a patient in his own clinic this year. The physician, who has performed
thousands of orthopedic surgeries during his career, found he needed a
right knee replacement. An active biker, Dr. Unatin put off surgery for
as long as possible, and then scheduled the procedure at his clinic, South
Bay Orthopedic Specialists, where his partners,
Nicholas J. Silvino, MD, and
Don P. Sanders, MD, could perform the operation.
“I couldn’t go up and down stairs. I couldn’t bike like
I used to. It was time for me,” he says. “But there is a gigantic
difference between doing this operation and having it done to you. It
was a humbling experience.”
The orthopedic surgeon has a chuckle and positive attitude that is contagious.
His office is filled with memorabilia: model planes in recognition of
his time as a flight surgeon in Vietnam and photos of his worldwide travels
and his youth in Florida. It is clear his quest to learn more about the
world and his community has never ceased. This curiosity served him well
as a patient.
“As the physician it is very difficult to truly appreciate what the
patient goes through. Sometimes we are not sensitive enough to the anxiety
of the patient,” he says.
Being a surgeon, Dr. Unatin clearly knew all the possible risks of knee
replacement surgery, which would seem like an advantage but in reality
elevated his stress level. For instance, the risks of anesthesia gave
him pause even though he had the benefit of knowing—and trusting—the
physicians and surgeons responsible for his care. He imagines patients
without as much insider knowledge could become even more anxious. Besides
worry about the operation or illness itself, the idea of taking time off
from work and/or extracurricular activities distresses many patients.
This type of stress can lead to sleep deprivation, changes in appetite,
attitude, depression, shortness in temper or breath. How a patient deals
with their anxiety can make a huge difference in their recovery.
“I had anxiety. When you do something within your own specialty you
know all too well every possible risk. It weighs on your mind,”
he says. “I made up my mind to just be a good patient. I did exactly
what I was supposed to do. I even went to the new patient orientation
Dr. Unatin decided he wanted to experience what other patients experience
at the clinic and the hospital. “You have to take yourself out of
the realm of being a surgeon and just be a patient. You have to follow
what doctors and nurses and physical therapists say.’”
The nurses, staff and physical therapists could not have been more professional
and calming, says Dr. Unatin. He has great confidence in the anesthesia
department and had the opportunity to ask
Steven Underberger, MD, to administer the anesthesia. The anxiety he experienced was directly
linked to his own knowledge about the surgery and his worrying over its
effects. He never realized how big a role stress plays, even months before
and after surgery, and now he’s much more sensitive to a patient’s
individual needs. “I’m more sensitive to when my patients
need surgery,” he says. “We don’t treat X-rays—we
treat people. I say, don’t rush into a big operation like this.
If all a patient has is a little arthritis on an X-ray, maybe it’s
not time yet. There are conservative non-surgical methods of treatment.
Wait until the issue is really affecting their daily quality of life.”
His experience as a patient reinforced Dr. Unatin’s belief that most
patients need to get in shape and lose a bit of weight in the months before
an operation. For best results in recovery, less weight, stronger muscles
and heart health count.
Dr. Unatin exercised using gym equipment and watched what he ate to lose
a bit of weight four months prior to surgery. Losing weight and keeping
in good shape can seem daunting for those who have reduced mobility, but
swimming and other options should be explored. And healthy eating is always
important at any stage of life. Exercise and healthy eating help to reduce
anxiety and allow a patient to just feel better. A positive attitude,
while not quantifiable by science, plays a critical role in health and
in recovery, Dr. Unatin adds.
If surgery is imminent, experts in the field say knee-replacement surgery
has evolved. Not only are knee prostheses state-of-the-art, surgical techniques
are less invasive and less painful than ever before. With the use of injections
and smaller incisions, post-surgery pain is significantly reduced.
Dr. Silvino, who performed Dr. Unatin’s knee surgery on April 14,
explains ways doctors significantly reduce post-op pain: “The femoral/sciatic
nerve block combination provides good results for partial and total knee-replacement
patients,” he says. “In the period right after surgery when
patients experience the most distress, they are practically pain-free.
Because patients are in less pain, they are more inclined to participate
in physical therapy. This allows for fast recovery and a quick return
The first thing to do after a knee replacement is rest, says Dr. Unatin.
Swelling, though typical, can be discouraging. “The first two weeks
you will be uncomfortable and swollen. Listen to your doctor and do whatever
you can to relax,” he says. “Do what PTs [physical therapists]
tell you to do. Walk to reduce the chances of blood clots forming, but
for two weeks, you can’t do too much, and alot of anxiety can emerge.”
Just knowing that anxiety may emerge can help lessen it. Dr. Unatin says
to count on some uncomfortable moments of doubt but know you are healing.
“The site of the surgery is warm. You may even think an infection
is forming,” he says. “But it will cool and once it calms
down by week three, you can begin slowly to gain range of motion.”
Dr. Unatin advises patients to begin working on strength and range of
motion during week three. Some physical therapists may disagree or have
other favorite means for this, but he gained strength and range of mobility
with a stationary bike, slowly and mindfully increasing duration and difficulty.
So how else does Dr. Unatin advise his patients now that he has had knee
replacement surgery himself?
First, it’s not going to feel like your knee for six to nine months.
“Your pain may go, but it won’t feel organically like your
own knee right away.”
Second, it will get progressively better as long as you get “incrementally
better every day by doing just a bit more.” Still, it’s a
balance. Don’t overdo it.
Third, be patient. “Patients should have patience. Listen to your
physical therapist. Learn from your PT. Pay attention to the exercises
you are given. Even if you can only go to a few PT sessions, you can learn
what you need to do at home.”
Fourth, be positive. “You’ll get there. I’m a cyclist.
My anxiety was, would I have the range of motion to bike? Five months
ago I biked on the Strand—not very fast, but I still did it!”
Dr. Unatin is clearly an inspiration. The physician hiked in Yosemite two
months after his operation, according to good friend and partner Dr. Silvino,
who took the hiking picture above and said his friend was “a great
Today, six months after his kneereplacement surgery, Dr. Unatin is back
in the office, back on the bike. You may even spot him biking on the Strand
or hiking in a neighborhood near you.