Physician loneliness is a thing. In Part 1, we discussed the impact of loneliness on our well-being. We explored the factors common to the lonely physician in modern medicine (the “Us” factors). Here, in Part 2, we look at the lonely physician and the systemic (“Them”) causative factors. Finally, we then explore potential solutions for the lonely physician.
We doctors are repeatedly rated as the most trusted of professionals by the public. They expect a lot from us, and for the large part, we deliver. But at what personal cost?
Certainly, while public trust in us is essential to our profession, we are not perfect nor are we concrete statues. Feeling unable to show our humanity and vulnerability means we have to hide our true feelings. As a result, this in turn may lead to the development of the lonely physician.
Modern medicine has been fragmented into narrowly defined, rigidly boundaried workspaces and job descriptions. Under pressure, we may feel the need to self-protect in order to manage our workload. Furthermore, the increasing size of practices and hospitals have negatively affected the professional culture in which physicians spend so much of their lives.
Our medical regulatory boards/councils/associations are taking an increasing interest in our personal lives. Things we do on holiday or on a night out can come back and haunt us. Social media evidence can be both blessing and curse.
Our medical regulatory boards/councils/associations are taking an increasing interest in our personal lives.
For instance, things we do on holiday or on a night out can come back and haunt us. Social media evidence can be both blessing and curse. In some countries, it is too easy for an angry patient to make life hell for an innocent doctor. Unfounded allegations may result in suspension, loss of income, loss of reputation, or worse.
Several high-profile cases of fellow physicians who have indeed failed in upholding Hippocratic standards have only reinforced the perceived need for increased regulation.
The commercialization and fragmentation of modern medicine have also destroyed an essential human bonding, burden-sharing, camaraderie-supporting safe place: the doctors’ lounge. While the idea of a safe space for people carrying huge burdens to eat and relax may be from a different era, there is much to be said for it. I would argue that the loss of the Doctors’ Lounge is a direct cause of physician isolation and loneliness.
For instance, meals (if eaten at all) are solitary, eaten at desks from plastic containers from home or takeout. They are eaten mindlessly while catching up on email, writing charts before the afternoon begins, or answering online patient inquiries.
Even in common spaces and nurses’ stations, everyone sits silently in front of a computer screen.
Moreover, the poor quality of available nutrition in hospital, evident in the the cold/microwave meals (if any) from a vending machine available at night, cannot be healthy.
In contrast, while the Doctor’s Lounge would be a “nice to have”, I am not sure that we could add it to the WHO essential drugs list at present. Yet, the function and spirit of such a place can be replicated, if not in the hospital, then online – hence our founding of Physicians Anonymous.
I am not alone in concluding that this set of factors makes it even harder for doctors to be open and honest about their natural and human vulnerabilities. This only increases isolation, making it harder for us to gain support, and when ill, to seek help for fear of professional consequences.
Likewise, these structural changes have led to an increasing sense of professional loneliness that not only threatens the quality of clinical care by replacing personal discussions about patients but also poses risks to physician personal and professional wellbeing.
On a personal level, many of us would love it if they brought back Doctors’ Lounges where we could, say, have complimentary beverages and healthy snacks or even a proper meal, and a quiet environment to relax and recuperate. Maybe have the daily paper, and a civilized discussion with fellows.
But perhaps that only ever happens in Hollywood, or my fertile imagination.
On the other hand, as John Frey 3rd has written in his excellent commentary on the loss of the Doctors’ Lounge: “Historically, family physicians moved among all the venues of medical care — office, hospital, community — and were a part of a connected professional community. That connected community was sustained in great part through informal gatherings of clinicians in hospitals, clinics, and professional organizations.”
In other words, there is no real opportunity for a genuine, safe connection between physician colleagues. We are too exhausted, afraid, defended, or simply time-poor. Our safe spaces are gone.
That connected community was sustained in great part through informal gatherings of clinicians in hospitals, clinics, and professional organizations.
Most importantly, there is clear evidence that increased support from family and friends reduces loneliness among resident physicians and subsequently reduces burnout. In the same vein, other research has demonstrated significant improvement in measures of burnout after providing targeted education to help identify these symptoms early on — before a negative event occurs. It makes intuitive sense, too: a burden shared is a burden halved.
For example, an innovative “ED Stories” Online Emergency Medicine Residency Community pilot showed that a virtual space appeared to provide a useful area for residents to post and react to difficult or emotional situations at their convenience. As a result, the authors reported that residents engaged with the online platform, while noting that it was just a pilo study, and no measures of wellbeing were taken,
That’s why we founded Physicians Anonymous: a safe doctor-only space to beat physician loneliness, combat disconnection, and improve wellbeing.
We intend that anonymity and careful screening to ensure only doctors can join will, overcome barriers to use of these types of platforms. Physician barriers, both real and perceived, include concerns around confidentiality, accessibility, and time commitment, and may inhibit participation
The sharing of meaningful experiences and stories with peers may improve interpersonal relationships and help strengthen the medical community. In addition, “unloading” some of our more difficult cases and challenges may help prevent internalization and demoralization.
Accessing secure anonymous peer support will empower physicians to know that they are not alone, beat burnout, challenge systemic issues, and maybe even thrive in medicine!
In addition, senior doctors can impact their juniors by normalizing emotions, allowing vulnerability, and highlighting the importance of self-care. This builds on the substantial role that peer learning plays in intern/resident development. Furthermore, we envision that Physicians Anonymous members can themselves be trained as peer facilitators to start their own local or online groups, spreading the knowledge and skills of peer support around the world.
In this article, we discussed the systemic factors underlying the lonely physician, and we explored possible solutions.
We hope that in providing the platform for accessing secure anonymous peer support, we will empower physicians. We intend for lonely physicians to know that they are not alone. Together we can beat burnout, bring back collegiality, and challenge systemic issues. Who knows, we may even learn to thrive in medicine!
