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    When physicians struggle with mental health

    Repair, restoration and relief are key ingredients for professional well being

    Thanks to the technical aspects of medicine, physicians know how to analyze and think in a scientific way. At their best, they listen to the body and figure out what it’s saying about the road to repair, restoration and relief.

    But even the most brilliant physicians often lack the capacity to see inside their own heads or view themselves as others see them. They may neglect or fail to notice the obvious: Burnout, violation of boundaries, depression, anger, substance abuse. Or they may understand they’re in trouble, but fear letting anyone know about their struggles.

    Read: 8 simple tips for happy patients

    “There’s a huge stigma and culture of silence in medicine around any kind of mental illness or showing emotion,” says Charles Samenow, M.D., MPH, an assistant professor in the Department of Psychiatry and Behavioral Sciences at George Washington University. “Emotional responses or admitting mistakes equate to, ‘I’m a weak, bad physician, I don’t belong here, I’m an imposter.’”

    So the physician gets deeper into trouble, becoming abusive or passive-aggressive. “They’ll do things like refuse to respond to tasks or not complete their charts or slowly respond to calls from nurses,” Samenow says. Co-workers suffer and patients could be put at risk.

    But experts say there are ways to fight back. Physicians can help themselves by becoming more aware. And health systems can send troubled doctors to rehabilitation programs designed to give them the skills to survive and thrive in their medical careers.

    How inner turmoil reveals itself

    Turmoil inside physicians can show itself in a variety of ways:

    Communication problems

    For some physicians, “emotional intelligence”—their understanding of themselves and others—may fail to keep up with their technical and scientific expertise, Samenow says. Some physicians are especially vulnerable, including those who’ve experienced abuse or faced rigid family expectations, says Samenow, who recently gave a presentation on physician well-being to medical professionals in Montevideo, Uruguay.


    Over time, physicians may fail to find meaning in their work. “When they lose the ability to understand why they are there, why they doing this job, it can become mechanical or rote and start to carve away at their wellness,” Samenow says.

    • Anger

    The uncertainty of medicine can trigger outbursts on the job or in a physician’s personal life. “The only way they know how to deal with the world is through anger,” Samenow says. “That’s when they throw things at nurses, knock instruments off the operating table, kick trash cans. Anger is the only strategy they have.”

    Boundary-crossing and addiction

    Physicians may abuse alcohol and drugs or have inappropriate sexual relationships with patients or colleagues.

    NEXT: Self-treatment can make a difference

    Randy Dotinga
    Randy Dotinga is a medical writer based in San Diego, Calif.

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