Are physicians addicted to medicine? Being both a physician and an addict (among many other labels, including some unprintable in polite company), in this article I will argue that medicine can be so intoxicating, even if it’s bad for us, that doctors can become addicted to it. Before too long, a medical life becomes a way of life until we don’t know any different. At which point it becomes difficult to imagine a different life, one of recovery, sanity, health, balance, control, and happiness.
Medicine is intoxicating. There is excitement, danger, challenge, sharp instruments, blood, shouting, beeping, life and death. Feces if you’re unlucky. Saving someone’s life, or at least making a positive difference to someone, gave me such a kick. And I’m not alone.
Such a cocktail of emotions. In a study of pediatric doctors, Kasman and colleagues reported the following emotions experienced at work:
“Positive emotions included gratitude, happiness, compassion, pride, and relief, and were triggered by connections with patients and colleagues, receiving recognition for one’s labors, learning, being a part of modern medicine, and receiving emotional support from others. Difficult emotions included anxiety, guilt, sadness, anger, and shame and were triggered by uncertainty, powerlessness, responsibility, liability, lack of respect, and a difference in values. Tragedy and patients’ suffering was the only trigger to elicit both positive (compassion) and difficult (sadness) emotions.”
Here I will argue that there are major overlaps between modern understandings of addiction and how physicians relate to their careers and lives in medicine. We’ll look at the diagnostic criteria for addiction and how it relates to physicians.
Being a doctor has striking diagnostic similarities with substance abuse disorder (SUD) according to the Diagnostic and Statistical Manual 5 (DSM-5). By the end of this article, we hope to have convince you that most physicians are addicted to medicine.
A SUD involves patterns of symptoms caused by using a substance that an individual continues taking despite its negative effects. Based on decades of research, DSM-5 points out 11 criteria that can arise from substance misuse. These criteria fall under four basic categories — impaired control, physical dependence, social problems and risky use.
Medicine is intoxicating. There is excitement, danger, challenge, sharp instruments, blood, shouting, beeping, life and death. Feces if you’re unlucky.
DSM-5 SUD criteria:
How many of us stayed at the hospital longer than our shifts required? Typically it was because the patients needed it. Or our work ethic did not allow us to leave with work “unfinished” even if our work hours were finished and someone else was now being paid to take over. Or we were people-pleasing and needed to show others that we were hard working. Or we just loved medicine so much that the hospital appealed way more than life outside (that was me at the beginning).
I appreciate that working hours are set by the employer and cutting them down may not be within our control. I am however talking about excessive hours – when legally and ethically we did not need to be there, but we were there anyway (physically or mentally), and it was just easier to do that than to stop.
I remember thinking a lot about the hospital when at home, and even missing the buzz, the machinery, the camaraderie, that particularly attractive team member (before I was married!).
I used to dream about the anesthetics machine and the joy of inducing and reviving patients safely.
Not exactly a craving, but I doubt accountants get the same as I described (I am willing to be corrected though! Addiction is not exclusive to medicine.)
Ever find that you needed more and more of a challenge at work to feel good about yourself? Mundane cases no longer gave me that sense of satisfaction.
This, I argue, is like tolerance, where an addict needs more and more of the substance to get the desired emotional effect.
Ever have time off and find yourself thinking a lot about your hospital, patients, colleagues? Ever start a vacation and not feel “normal” for about a week, by which time you start to enjoy and relax, and it’s time to get back to work? (Vacations should be a minimum of 2 weeks for this reason). Ever expect to have a day off and then get called in unexpectedly? Did you ever get a sense of relief walking in the hospital door, like you were home?
I had all of these, and they are in my view not far off a mild withdrawal syndrome. This is a physical and mental period of discomfort when stopping the drug of choice, which fades over time, but is relieved quickly when the drug is taken again (going back to work).
Ironic, given how responsible we are towards our patients.
How many parents’ evenings, sports events, family events, and all those interactions that make for healthy happy relationships did I miss because of practicing medicine?
How many times did I avoid a difficult conversation with my wife citing exhaustion from work?
How many times did I just want to sleep instead of playing with my kids?
I say this with a heavy heart. Medicine is bad for us. Yet we carry on despite its negative effects on our physical and emotional health, and our relationships. The data?
Another key reason why physicians don’t reach out for help is that they believe that they can fix themselves. Despite all the evidence to the contrary, they persist with the delusional idea that because they are so good at fixing others they must be able to sort themselves out.
This is a common cognitive distortion found in addicts. Until they reach a point of realization – “I can’t control this situation anymore” – they will just carry on.
When I talk to my non-medical friends from school, now in their 40s and enjoying family life and mid-career success, I am struck by how unbalanced my life became as a doctor.
Sure, medicine is closer to a religious vocation than most other professions, so there will be some sacrifice involved. But if I look objectively at my work-life balance compared to my friends, I see:
Of course, I don’t really know what their lives are like, and I know that social media presents an untrue glossy narrative, but I also know that they simply have more time and bandwidth outside of work. For the most part, they are able to switch off.
My point here is that they have what scientists call ‘alternative pleasures’. Here I mean enjoyable things outside of the hit we get off of medicine.
Before I left clinical medicine, I had no hobbies. When I did get a hobby, it was another addiction. Not my finest life choice.
Ever find that you needed more and more of a challenge at work to feel good about yourself? Mundane cases no longer gave me that sense of satisfaction.
This, I argue, is like tolerance, where an addict needs more and more of the substance to get the desired emotional effect.
In this article, we have argued how a career in medicine meets the diagnostic criteria for addiction. While written tongue firmly in cheek, there is a core of truth to it: medicine can be unhealthy, yet we carry on or feel unable to make healthy changes.
In the next article, we explore how to get sober if you’re addicted to medicine.
