Imagine what it must be like to go from being the trusted, knowledgeable

caregiver to being the one who is in need of care. No one actually likes

being a patient, of course, but resistance on the part of physicians is much


Many physicians equate being a patient with being flawed and unable to

function as well as one’s peers. This is in part true. Anyone who is feeling

unwell, whatever their occupation, may not be able to work as they do

normally. But many physicians can’t allow this for themselves. So they work

through all kinds of symptoms or changes in performance and hope that,

magically, it will all go away. That magical thinking may go something like

this: “If I just work hard and help my patients I will be okay because I’m

doing good (translate as important) work”. Religiously bent doctors might

consider this “doing God’s work” and convince themselves that, because

their work is sacred, they themselves won’t get sick.

“Presenteeism” is the term used to describe physicians who go to work ill. They are

dedicated to their patients and do not want to let them down. They cannot and will

not take “time out” for themselves. They cling to their medical mantle and will not

relinquish it, even for a short time.

A Little Knowledge Can Be a Dangerous Thing

Ignorance can be bliss but this is a luxury that’s systematically denied to

doctors virtually from the moment they enter medical school. By graduation

they must have a working knowledge of the signs, symptoms, and treatment

of diseases across the medical spectrum. Here is an example that illustrates this

with paralyzing consequences.

A surgeon is going through a nasty divorce. She knows her self-esteem has taken a

hit and she begins to develop panicky feelings the night before she is scheduled to

perform a routine operation. She doesn’t sleep well, and each day her panic attacks

seem to be getting worse. Although it’s been more than a decade since she spent

four weeks doing her psychiatric clerkship, she hasn’t forgotten how awkward and

impotent she felt trying to help her patients with depression. Now, twelve years

later, she panics and thinks she might be having a nervous breakdown. She begins

to worry that she’s heading for a psychiatric unit herself. She’s terrified.

She wonders if she should call a friend and former classmate who is now

a psychiatrist. But she doesn’t. She thinks she might be over-reacting and

just needs to tough it out. Don’t lots of doctors go through divorces

without consulting a shrink? She remembers that she has a few sleeping pills

prescribed by her doctor five years ago after a miscarriage. She takes one. It

works. She’s now sleeping better but she’s still worrying a lot. She’s afraid of

making a mistake in the operating room or missing something when

assessing a patient before surgery. She decides to “up” her running schedule

and join a spin class at the gym. It helps a bit, but she can’t shake the feeling

that she’s not herself. She’s lost almost ten pounds, and it shows when she

looks in the mirror. She again considers calling her old friend but again

decides against it. She’s simply too embarrassed. She feels like a wimp and

redoubles her efforts to “get a grip.”

Unfortunately, this story is not unusual. A little medical knowledge can

be a nerve-wracking and dangerous thing. Possibly for the first time in a

very long time, physicians don’t know what to do, but they are still reluctant to

take the next logical step, which would be to get an opinion from a mental

health expert.

Take home message for therapists of physicians?  Be kind and judgment free. It’s

not  always easy for folks to knock on our door and ask for help.

You are reading

Physician, Heal Thyself

Becoming a Patient

Why Physicians Resist

The Irony of Physician Suicide

Another consequence to think about

A Lethal Trifecta

How three intersecting forces put doctors at risk for suicide