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Physician, Heal Thy Self

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By:  Rahul N. Mehra, M.D., CEO National Center for Performance Health

In the spring of 1986, I proudly announced to my parents and sibling that I had decided to pursue psychiatry as my chosen career path – specifically child psychiatry.  I was about to begin my fourth year of medical school at the Medical University of South Carolina in Charleston.  Psychiatry was my last clerkship third year.  My proclamation was met with a paucity of enthusiasm.  In an otherwise extremely supportive and nurturing family, my announcement evoked really no response other than from my sibling (ironically a family medicine physician) who stated with the insight of a goat, “you know, working with crazy people all day will make you crazy.”  I wondered to myself, gosh if I were an oncologist, would I get cancer?  Thus began my entrance onto the stigma highway.  As my nature, I quietly listened to the concerns.  But also as is my nature, my inner resolve intensifies when I encounter challenges.  Thirty one years later, my career as a board certified child, adolescent and adult psychiatrist has gratified me beyond my expectations.  I am the founder and owner of the National Center for Performance Health (NCPH).  NCPH is a multi-state, for profit organization focused on destigmatizing mental illness, raising awareness, and improving access for professionals, families, employees, K-thru graduate school students, collegiate/professional athletes and children in foster care.

Reflecting on my family’s initial response, I soon realized how common place stigma was.  Stigma is a powerful and destructive force.  Many factors contribute to stigma, but at the core of it lies – how do you address something you cannot see?  Emotional wounds do not bleed but do scar.  Those scars, however, are invisible to the untrained eye.  The invisibility of the illness makes it ripe for humor and ridicule.  Humor helps minimize our discomfort and uneasiness surrounding the topic.  Terms such as “shrinks”, “crazies”, “looney bin”, and “psychos” are just a partial list of commonly used and socially accepted terms that reinforce stereotypes and deter people from seeking help. Serious help may be a matter of life or death.  Imagine a woman with breast cancer being called “lumpy”!  Would we tolerate this?

As physicians, we are inherently skeptical of something we cannot really see, auscultate, x-ray or get a lab result.  If we cannot see it in others can we realistically see it in ourselves?  But what if it is one of us, a peer, a resident, junior partner or practice owner who may be in emotional distress?  Early identification of emotional distress is essential to mitigate long-term effects on work performance, academic success and healthy relationships.  This emotional distress may directly impact quality care to patients, staff relationships, risk exposure and jeopardize the financial bottom line.  A professional and personal axiom I live by is that our greatest strengths are also often our weaknesses.  As a profession, we have to be confident, decisive, hopeful when there is no hope, and often void of emotionality.  We maintain our role as compassionate healers but become dehumanized to ourselves and those closest to us.  We cannot and should not appear to be weak or vulnerable.  Yet we lose who we are, what we are.  I accept and acknowledge that some emotional detachment from our clinical work is not only a healthy coping mechanism but is essential to being a successful physician.

However, this detachment, when managed ineffectively, is a scalpel that cuts deep into the essence of our being.  With surgical precision, it serves to disrupt our social and spiritual connectivity essential to our survival.  This delicate balancing act is dangerous and if not self-monitored can rapidly lead to poor self-care, chaotic relationships, and declining financial health.  Ultimately, it robs us of the very attribute that drove us to medicine, our compassionate spirit.

The greatest challenge facing us is not MACRA, EHR, declining reimbursements, opioid prescribing or practice acquisitions.  The greatest challenge we are facing is ourselves!  Our inability or unwillingness to recognize and confront the fact that we (each one of us individually) are ultimately responsible for the course our life takes, the relationships we have and whether or not we are content at the end of each day has left us in a model of learned helplessness.  We need to regain self-awareness and self-determination.  How do we do that?  We invigorate our resiliency.  One way to do this is by asking for help.  Asking for help from a trusted friend, spouse, college roommate, adult child or rabbi are some examples.

In Western society, the premium placed on personal values of self-reliance, while tremendous and admirable can be self-limiting and isolating.  We must acknowledge that we are human first and foremost.  Part of the human existence, is having worries, fears, doubts and uncertainties. Part of continued growth and emotional development is to address these challenges head on irrespective of one’s age, social or moral value system.  The issue of physician dissatisfaction and unhappiness is literally and figuratively killing us.  The culprit is our reluctance, hesitation and self-perception that if we ask for help we are weak and vulnerable.  I maintain that by not asking for help leaves us weaker and even more emotionally vulnerable.  Culturally, we worry about societal norms.  Hospitals, clinics, academic institutions are often reluctant to vigorously promote physician health and well-being.  The hesitation is rooted in brand equity.  Fear that brand equity and community support will be compromised.  Sustainable, meaningful solutions will not be found in slick on-line modules, yearly retreats, 24/7 hotlines, monthly newsletters or quarterly, physician wellness committees or periodic “burnout seminars”.  These things suffice to check a “feel good” box that some action was taken.  Bon a fide solutions will be found in hand to hand, on the ground combat.  Institutional and organizational leadership must create, design and implement clearly defined objectives which establish a sustainable culture around emotional well-being.  To do this will not be easy, will take time but can be accomplished with an unwavering commitment.  Our profession depends on it.

A physician’s request to see a counselor, coach or psychiatrist should be normalized as if we were dealing with a broken arm.  Because, a broken spirit has far more serious and detrimental consequences.  As the owner of a behavioral healthcare organization, I am frequently challenged by the question, “what is the return on investment?”   In the words of my dear friend, Dr. Loren Murfield who lost a son to suicide, “have you ever considered a return on compassion?”

I am proud to say that HCMA leadership has taken a bold, progressive and compassionate step to addressing the topic head on.  HCMA has launched the Physician Wellness Program as a major step to physician health and well-being.  I applaud the HCMA for taking this step.

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