FRIENDS, PARTNERS AND ADMINISTRATORS always hope to catch loved ones and colleagues on the way down before they hit bottom. But there are days I pull back the curtains only to realize I am meeting a colleague on the edge. Other times, I have been too late to provide the intervention that a colleague needed. Handling these situations is a never-ending educational process similar to learning medicine.
Rarely are circumstances black and white. When a physician is clearly incompetent or severely mentally ill, it makes most decisions on how to proceed fairly straightforward. Borderline situations are tougher and much more common. Fortunately, those are also the situations where everyone is more likely to have favorable results. We all prefer stories of redemption and resurrection over annihilation.
I often draw on my training as a certified personal trainer working with physical injuries as a helpful template for working with hurting colleagues. I have learned to look at doctors on the edge as emotionally injured, in the same way that trauma to a ligament causes emotional pain (as much as physical) to somebody who can no longer train the way they want to. In both cases, we need to acknowledge that healing is possible only by working together.
The following steps can be helpful:
1. Acknowledge the injury. This is often the hardest step for physicians to take. While doctors are adept at recognizing maladaptive behaviors that contribute to illness in patients, we often miss our own. And being a workaholic is among the maladaptive behaviors we actually embrace, one that is rewarded in medicine. A doctor who works only 50 hours a week is often considered a lightweight. In a field full of talent, motivation and work ethic are often what separates each of us from the rest.
The injuries we can’t see are some of the toughest to work with. Some patients with traumatic brain injury (TBI) have heartbreakingly told me they would prefer that their scars were externally visible; that way, other people would be able to at least see the damage and better understand what patients were going through. But at least those TBI victims have acknowledged that there is something they need help with. The reason 12-step programs make “admitting there is a problem” the very first step is that all the other steps won’t work without it.
2. Visualize goals. What is the desired end point? Create a mental image of the professional you want to be in the future because focusing on that image will help you achieve it. Athletes do this to create new neural pathways that improve performance. Visualization remodels thoughts and behaviors.
3. Set an action plan with realistic expectations. Maybe you won’t achieve Mother Theresa’s compassion combined with the medical achievements of Dr. William Osler. But think about the qualities you respect in your heroes, mentors and colleagues. Write those qualities down and remind yourself of those traits before you see your first patient each day.
4. Provide resources. Struggling physicians need a team approach. As a colleague or administrator, I can help with certain things, but nobody is an expert in everything. Just as a torn ligament may need surgical repair, the brain may need a mental health professional to guide therapy.
I have seen physician health programs work. Certain members of the public may look at these programs as a way to coddle docs in trouble, but the reality is that they can save the lives of doctors and patients.
Doctors are like any other human being: We are prone to medical, psychiatric, emotional and situational stressors. Proactively getting into a physician health program, via self-referral or at the urging of a colleague, protects the doctor and the public, and early intervention increases the chances of success.
Doctors who complete a well-run program actually say they would return to that program in the future if needed. These programs also teach skills that reduce doctors’ risk of subsequent malpractice claims and improve patient safety.
5. Inspire. Struggling colleagues have to believe success is possible.
6. Keep track of progress. When you live with a puppy, you don’t notice how fast it’s growing “but your friend who visits every couple weeks will. When we see progress, we need to reinforce recovering doctors with positive feedback.
7. Celebrate victories. When you have overcome a tribulation, you become a stronger person. You also become a better doctor as you learn to relate to your patients’ burdens. Persevering through struggle is the only way to know victory. Not everybody has the same struggle and that makes your victory unique.
Gil Porat, MD, is chief medical officer for Penrose Hospital and St. Francis Medical Center in Colorado Springs, Colo. He’s also a practicing hospitalist. You can listen to Dr. Porat’s free “Hospital Medicine” podcast on iTunes.