In this article, I present Part 1 of my personal physician burnout story, and discuss how it led to my co-founding Physicians Anonymous.
I have wanted to be a doctor since about the age of 4 or 5, or so my parents tell me. Maybe it was because I had a severely disabled family member. Maybe because the doctor up the road always seemed more financially secure than my family. Perhaps it was my love of biology at school and my aptitude for the sciences and people.
Doogie Houser MD, ER, and Rescue 911 (don’t judge me!) clearly played a role too.
Whatever it was, I was determined to get that MD after my name. So I worked and worked, got into a good med school, worked part-time to fund my studies, specialized, did a research doctorate., and continued on the conveyor belt. Got married, had kids, found a good job at a busy hospital. Carried on research “in my spare time”. Sat on charity boards and the PTA. Dabbled in start-ups before health tech was a thing.
Until the wheels came off…
I was at one point “suicidal with planning and intent”....A carefully thought out cocktail and a sea swim would result in a tragic "accident".
My career and life crashed to a halt after 25 years in clinical medicine. A combination of a particularly shameful addiction and recurrent depression became too much and I hit rock bottom.
I was at one point “suicidal with planning and intent”. And I had the means and knowledge to do it so that (I thought) the insurers wouldn’t find out it was suicide and my wife and kids would get a pay out. A carefully thought out cocktail and a lake swim would result in a tragic “accident”.
Medical knowledge in the hands of a suicidal physician can be deadly.
As an affluent, respected physician, confident in my position, well-liked and admired by society, yet suffering inside, why did I not seek help? In my case, I knew something was wrong. My spouse and my best friend said the same. So did my Mother.
I ignored them and blamed work.
Perhaps if I’d taken an online burnout or depression screening test, I may have recognized it.
So why, with all my training and knowledge of the body and mind, why did I not reach out? Indeed, why do so many of us suffer in silence? What are the barriers to us physicians seeking help?
The reasons, as happens so often, are complicated and multiplex. Shame, denial, guilt, fear to start with.
So why, with all my training and knowledge of the body and mind, why did I not reach out?... Shame, denial, guilt, fear...
Fear of disclosing to my hospital, State Licensing Board, insurer, Family Physician. I did not want a well-meaning colleague or manager to refer me to an impaired physician program or Practitioner Health Program (PHP)*. I did not want my registering authority to know. Nor my colleagues. Least of all my patients.
How could they trust me again?
Fear of appearing less than perfect or competent. Guilt that my decisions and behaviors had led me to this point – “how could I have let it go this far?”.
Not even my spouse or friends knew how far down I had fallen. I felt completely alone.
It turns out that I was not alone. Thousands of my fellow physicians were struggling (>50% of 1 million US physicians are burned out.) Some of them were crashing and burning like I was.
What’s the difference between guilt and shame? I only understood this in recovery. Guilt is that feeling about the behavior being wrong. Shame is that feeling that we are wrong.
Guilt about my behavior became shame. I became the problem. Shame was so deep-rooted and in the shadows, and I had built up such strong defenses over the years, that I almost didn’t feel the shame anymore.
Also, my life was comfortable. There was no way I was going to look under the hood to investigate that occasional burning smell in my car.
Thousands of my fellow physicians were struggling. Some of them were crashing and burning like I was....I felt completely alone. It turns out I was not alone. >50% of us are burned out.
In this article, I have described my physician burnout story: from the heights of (conventional, Western-defined) success to my rock bottom. This included suicidal thinking and planning with intent.
Thanks to the support of fellow physicians, I was able to see that suicide was not the answer — or indeed any answer. I thank a power greater than myself that I am alive today in order to do this work with my fellow doctors in distress.
Read on to find out more about my recovery in A Physician Burnout Recovery Story.
I am prepared to admit I am wrong. I am often wrong, being human and all. Ask my ex-wife.
During the last 2 years of the Physicians Anonymous journey, I have heard PHP horror stories — and PHP salvation stories.
The good ones, so far, outweigh the bad ones. It appears quite random as to whether a physician works in a state where they are treated with compassion and respect, or with suspicion and punishment.
There is a huge difference between a physician proactively taking Paxil or getting CBT in order to be healthier and arguably safer, and a doctor with 6 DUIs or severe depression with suicidality.
Unfortunately too many systems treat them all the same, based on outdated assumptions and fears of what an “impaired doctor” may do. Our litigious society plays a big role here: organizations cover their backs for fear of being sued.
Having said all that, during my breakdowns, I avoided PHPs out of fear that I would lose my licence. The threat of my intimate details “being online forever”. Of having to explain to my colleagues and administration. I got some bad advice and I was living in terror of losing my beloved vocation.
Yet it is precisely because I avoided the PHP that I lost my license. If I had engaged earlier things could/would (very likely — who can say?) have been different. Having met my own and other areas’ PHP senior people, I can say with confidence that the ones I have met care deeply about physician well-being. They want to help us get better and back to doing what we do best, helping patients. I did myself a disservice by trying to go it alone. PHPs also have to navigate state and national law, misinformation, fear, and mythology No doubt the latter three scenarios are based on the sad stories of our ill colleagues which then get amplified by the media.
Too few of us are prepared to engage, even with “anonymous” support programs if they are affiliated with “regulators”. If the anonymity is there, get the help. Even if it is not, and you need it, please take it.
It would be really useful for Physicians Anonymous to hear more about your experiences with PHPs and regulatory systems wherever you are in the world. Please contact us in confidence.
Physicians Anonymous maintains a live global list of physician suicide prevention resources accessible here:
Physician Support Line (US only)
Psychiatrists Supporting Physicians
Click here or call:
1 (888) 409-0141
Free & Confidential. No appointment necessary. Available 7 days a week.
If you are having thoughts of wanting to end your life,
please first call the National Suicide Prevention Lifeline.
1-800-273-8255 or call 911 if in imminent danger.
