Even the most brilliant physicians often lack the capacity to see inside their own heads or view themselves as others see them. They may neglect or fail to notice the obvious: Burnout, violation of boundaries, depression, anger, substance abuse. Or they may understand they’re in trouble, but fear letting anyone know about their struggles. Help is available when physicians need a path back to professional health. Learn more
Thanks to the technical aspects of medicine, physicians know how to analyze and think in a scientific way. At their best, they listen to the body and figure out what it’s saying about the road to repair, restoration and relief.
But even the most brilliant physicians often lack the capacity to see inside their own heads or view themselves as others see them. They may neglect or fail to notice the obvious: Burnout, violation of boundaries, depression, anger, substance abuse. Or they may understand they’re in trouble, but fear letting anyone know about their struggles.
“There’s a huge stigma and culture of silence in medicine around any kind of mental illness or showing emotion,” says Charles Samenow, M.D., MPH, an assistant professor in the Department of Psychiatry and Behavioral Sciences at George Washington University. “Emotional responses or admitting mistakes equate to, ‘I’m a weak, bad physician, I don’t belong here, I’m an imposter.’”
So the physician gets deeper into trouble, becoming abusive or passive-aggressive. “They’ll do things like refuse to respond to tasks or not complete their charts or slowly respond to calls from nurses,” Samenow says. Co-workers suffer and patients could be put at risk.
But experts say there are ways to fight back. Physicians can help themselves by becoming more aware. And health systems can send troubled doctors to rehabilitation programs designed to give them the skills to survive and thrive in their medical careers.
Turmoil inside physicians can show itself in a variety of ways:
• Communication problems
For some physicians, “emotional intelligence”-their understanding of themselves and others-may fail to keep up with their technical and scientific expertise, Samenow says. Some physicians are especially vulnerable, including those who’ve experienced abuse or faced rigid family expectations, says Samenow, who recently gave a presentation on physician well-being to medical professionals in Montevideo, Uruguay.
Over time, physicians may fail to find meaning in their work. “When they lose the ability to understand why they are there, why they doing this job, it can become mechanical or rote and start to carve away at their wellness,” Samenow says.
The uncertainty of medicine can trigger outbursts on the job or in a physician’s personal life. “The only way they know how to deal with the world is through anger,” Samenow says. “That’s when they throw things at nurses, knock instruments off the operating table, kick trash cans. Anger is the only strategy they have.”
• Boundary-crossing and addiction
Physicians may abuse alcohol and drugs or have inappropriate sexual relationships with patients or colleagues.
Michael F. Myers, M.D., professor of Clinical Psychiatry with the Department of Psychiatry & Behavioral Sciences at SUNY Downstate Medical Center, urges physicians to take stock of themselves. “Your body and your mind are telling you that something’s got to give if you find that you are unhappy and drinking more or self medicating and writing prescriptions for yourself,” he says.
Consider cutting back on work and finding time to exercise, he says. “There could be a lot going on in your life that needs to be dealt with, especially if you’re getting complaints at home from your spouse or kids. It’s amazing how many physicians don’t believe that they can talk to their family about this.”
Also read: 10 things never to say to your patients
A visit to a therapist may be in order, or it could actually BE an order. In some cases, a superior may demand that a troubled physician get help from a mental-health professional.
“When I get someone referred to me who’s the CEO of the hospital or the dean of the medical school, they’re usually upset and offended that people have complained,” Myers says. “But they usually soften up after they’ve had a chance to pour their heart about how offended they are. Then I have the privilege of helping them let out emotions that they aren’t allowed to express in their lives.”
Physician rehabilitation programs step in when doctors can’t repair themselves on their own.
“There are many different ways for physicians to get help and the resources available often depend on the severity of the problem, illness or offense,” Samenow says. “Rehab can be anything from additional training to long term residential care."
Samenow helped to evaluate the program at the Vanderbilt Center for Professional Health, which has treated more than 5,000 physicians who’ve misprescribed narcotics, violated sexual boundaries and engaged in other kinds of disruptive behavior.
Certain medical specialties come with their own unique sets of challenges, Samenow says. Anesthesiologists have greater access to opiates are more likely to have substance abuse issues, while obstetricians and gynecologists have higher rates of sexual boundary violations.
Whatever the situation, the Vanderbilt program focuses on combating isolation. “We believe that doctor rehabilitation involves professionals who are used to dealing with doctors and an environment that places physicians with other physicians,” Samenow says. “When a doctor gets in trouble they feel very alone. The therapeutic process helps them realize that they’re not alone or some weird outlier. There are other physicians who also struggle.”
In addition, the Vanderbilt program encourages physicians to learn how to cope when they feel overwhelmed. “They’re flooded by anger, fear or anxiety when they’re in these huge anger outbursts or narcissistic rages,” Samenow says. “We help them understand their triggers and how to cope with them.”
• Employers, universities or local medical society may offer programs to support physician wellness and assist distressed physicians.
• The Institute for the Study of Health and Illness offers insight into finding meaning in medicine: www.theheartofmedicine.org
• The AMA offers a physician’s guide to personal health: https://www.ama-assn.org/ama/pub/physician-resources/physician-health.page?
• Vanderbilt University (www.mc.vanderbilt.edu/root/vumc.php?site=cph) and Menninger Clinic (www.menningerclinic.com) offer programs for physicians in crisis.
• Federation of State Physician Health Programs is a non-profit organization devoted to improving physician health. www.fsphp.org.
• ePhysicianHealth.com offers insight into physician wellness
• The International Conference on Physician Health is sponsored by the American Medical Association, Canadian Medical Association and British Medical Association. It is held every other year and next scheduled for September 2016 in Boston. Details: www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page