“How are you”?
“I’m fine, thanks”.
Depending on which brand of English you speak, fine might be “awesome”, “doing great”, or “things could not be better”.
Often, however, “I’m fine” is just a throwaway term without meaning. More concerning is when we are not ok but we say we are. And most concerning is when we don’t even know we’re not ok.
But no one is fine every day of the year for the rest of their life. We all go through mental and physical winters. Sometimes we’re not fine. But a lot of us keep pretending we are.
So, we as a profession are not fine, and I am no exception. Throughout my medical career I would say I was fine when in fact i was one or more of:
Let’s look into these a little deeper…
If you are a physician, there’s a >6 in 10 chance you are NOT fine:
While this may technically not be f***** up, am I the only person that thinks this is wrong? A group of extremely resilient, conscientious, hard-working, smart, dedicated professionals who routinely go the extra mile at great personal cost, more than half are burned out or mentally ill? And the number one reason is not lack of grit, personal failing, or moral weakness: it is work-related stress.
That situation is messed up.
I remain convinced that it was a fluke I got into med school. The fact that I passed med school, residency, fellowship, and various other post-nominals hasn’t changed that fundamental insecurity. It is not logical. If I didn’t have the brains and resilience to survive all that then maybe I could justify my fixed false belief.
Nevertheless, this insecurity was a strong factor in my ongoing impostor syndrome.
Doctors are more prone to neurosis – broadly defined as excessive worry, anxiety, or obsession – than the general public. Good thing if that translates into high quality care where diagnoses and abnormal lab results are not missed; less desirable if it drives a conscientious physician to extreme levels of anxiety, distress, or worry through working in a system lacking in resources or causing moral injury.
How many of us have cried at work? An Australian cross sectional study using self reported questionnaires found that crying was frequent in hospitals: 57% of doctors and 31% of medical students had cried at work at least once, and women cried considerably more often than men
This is a good thing – well the letting it all out is. The at work thing…not so much.
Less helpful is if we blow up, get angry, throw a scalpel, or say things we regret to staff or patients.
Emotional blowups are not uncommon in medicine. There is even a term – “disruptive physician”. But let’s be honest: there are also times when doctors act out like any human might in the middle of a stressful situation.
Either way, emotional explosions are another sign that the medical system is not fine.
It’s ok not to be fine. In fact it’s normal. In his book, Get Out of Your Own Way, psychiatrist Mark Goulston MD talks about the counterintuitive nature of acknowledging pain.
He writes, “Admitting to yourself that you are upset or in pain can make you feel exposed. You fear that acknowledging a bad feeling gives it more power. The pain might get worse. You might not be able to tolerate it.”
When you have negative emotions, your first response is usually to downplay them or to run away. But as Goulston argues, “the opposite is usually true: recognizing a feeling releases pent-up tension and makes you feel better rather than worse.”
Physical pain can threaten your liveliness. Emotional pain can threaten your life.
The first step to being genuinely fine is moving past denial into acknowledgement. The next time you feel bad about something, acknowledge the situation. It’s as simple as saying, “I’ve had a headache for three weeks. I don’t feel okay.” Or if it’s something emotional, it could be something like, “I feel overwhelmed at work.” Bring it out in the open.
By labelling what you’re going through, you will not only feel better about the situation, you’re more likely to find a solution. The last thing you want is to pretend you’re fine when you’re not.
It doesn’t have to be a DSM5 or ICD code. Just name the emotion. If, like some of us, it’s too complicated, then “Not fine” is a good start.
What you are going through is normal. Our medical-industrial system which is designed to put profits before patients means that there is never enough resource for patient needs. We will always be stretched too thin. Awful ethical decisions will need to be made.
Moral injury is likely in these scenarios, and because you are human, it’s normal to feel the way you do. We all have individual levels of stress tolerance, and when work stress levels are higher than what we can tolerate, we are unlikely to be fine for long.
You are not alone. 6+ in 10 of us are suffering. Think of 9 colleagues. Nomatter how accomplished, serene, and professional they seem, there’s a greater than even chance they are going through comparable difficulties to you.
It can however be difficult to share with colleagues in the same team or hospital. That’s one reason why we set up our Physicians Anonymous free peer-support group meetings. Where we don’t need to know your name to help with your shame. We have walked the corridors in your scrubs late at night.
We know your pain. We know it’s ok not to be ok.
In this article, we’ve explored how saying we’re fine is a reflex when we are not ok. Fine more likely means we’re messed up, insecure, neurotic, and emotional. The first step is to acknowledge the emotion, then name it , normalize it, and share it.
So instead of keeping your emotional pain in the dark, and reflexively saying “I’m FINE”, we encourage you to bring it out to the light. Shine light on the shadow and shame and it will be easier to manage.
Join our Physicians Anonymous confidential peer-support groups here.
(Please share the existence of our groups at your hospital and on social media!)
For individual PA-approved physician-to-physician coaching support – completely off the record – please click here.