With considerable personal expertise, I read Spiro and Mandell's "When Doctors Get Sick" [1]. I have pandysautonomia and widespread rheumatologic abnormalities, have had four extended hospitalizations, and have been on total disability more than 3 years.

Being seriously ill has certainly not been, as the authors stated, "a foretaste of retirement" or "the leisure for reveries." Being ill demands reevaluating priorities, a task that requires challenging introspection, and is a far cry from the ease and pleasure implied by the authors' choice of words. Illness leads to a descent into darkness and the unknown. The physician-patient, stripped of role and clothing, becomes a vulnerable human being. Many of us hold on desperately to our "knowing role"-reading radiographs, as the authors point out. But when illness becomes serious enough, we physicians are forced to become real patients. Illness saps clarity from cognitive processes. We need the peace of mind that comes from having physicians whom we trust both medically and emotionally make decisions in our behalf. Our physicians can help us give up control by empathizing and trying to help us feel more cared for.

When I became ill, I pushed myself to continue seeing patients when my hands were too swollen to hold a pen and my eyes were too impaired to review the medical charts. I dragged on not to brag but rather for fear of repercussions from my supervisors. When I became too ill to work, my rheumatologist insisted that I not do my month of ward attending. Not fulfilling this time-honored role was met with skepticism from colleagues. Was I not enough of a doctor to drag myself to rounds? Was I not committed enough to academic medicine? Or worse, was I simply malingering and wanting a vacation? The routine evaluation recommended by Spiro and Mandell would not have affected these overly demanding judgments.