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When Michael F. Myers, M.D., was in medical school, a roommate committed suicide. That incident profoundly influenced the direction of his medical career and life's work. He went on to become a psychiatrist who treats physicians and medical students.
Because of his work with suffering physicians, Myers challenged psychiatrists at a recent meeting in Alberta to "do a better job of looking after our psychiatrically distressed medical colleagues" and recommended several ways psychiatrists can offer physicians help.
"We don't have to look far to see the anxiety, demoralization, job uncertainty, anger, sniping, and exhaustion in many of our fellow physicians," said Myers, who is a clinical professor of psychiatry at the University of British Columbia in Vancouver and APA's Area 7 trustee.
Depression seems common among physicians. Myers noted that six physicians committed suicide in British Columbia between June 1996 and June 1997.
"That combined with the three residents who died by suicide in one year in Manitoba and an unknown number of other physicians across Canada constitutes a national tragedy," he said.
"I am convinced that there are immense challenges for psychiatrists in the field of physician well-being. Many groups and individuals are turning to us for help and direction. Yet if we caretakers err on the side of biological reductionism or psychoanalytic orthodoxy, we miss a lot. We do not see or hear or relieve the suffering of colleagues who come to us for help."
Physicians are reluctant to become patients because they fear being exposed, judged, abandoned, or rejected by the treating physician.
"These fears are not always irrational. There is now significant literature on shunning by doctors treating other doctors," Myers commented. "But even if our treating physician doesn't physically abandon us, many physicians do reject parts of us, which can be as hurtful, perhaps even more hurtful, than complete abandonment."
Becoming a patient also means relinquishing control and accepting a subordinate status, which is not an easy task for physicians, said Myers. He quoted a cardiologist patient of his: "I'm petrified sitting here opposite you. Thirty minutes ago I was a physician. I want to trade places with you and put my white coat back on. I want to get the hell out of here."
Becoming a patient, however, can also bring relief to distressed physicians because they now have someone to look after them and instill a sense of hope in them, Myers commented.
Myers observed that when physicians become ill, their first reactions are denial and minimization of symptoms. "We must watch for this when we treat physicians with depression. Given the feared consequences of disclosure, many will deny that they are suicidal, sometimes dangerously so," Myers stated.
Physicians also procrastinate and avoid seeking health care. "Thus, many will be very ill when they call us and do not have family physicians or, even if they do, will bypass them."
He pointed out that nearly all physicians who consult psychiatrists feel embarrassed. "They live with terrible shame that is either a symptom of their illness or [a result of being] a physician who does not feel well," Myers said.
Physician-patients commonly experience a sense of failure and guilt, describing themselves as losers and pathetic.
"They feel that they are letting others down-other physicians on the service or practice, their families, their patients, their students, basically everyone in the world including us," Myers observed.
He advised his colleagues "not to miss the anxiety behind the calm facade in some of our physician-patients. The characteristic armor that allows physicians to do their daily work may be out in full force when physicians sit opposite us in our offices."
Physicians are often wary of their colleagues who are psychiatrists. "We must be available, clear, thorough, accepting, and often quite concrete in our explanations," recommended Myers.
"We should expect to feel more anxious treating other psychiatrists who have a similar or greater knowledge base than our own," said Myers.
"If our psychiatrist patient is senior to us, or someone who is or whom we perceive as more accomplished, successful, or simply brighter, we should note that. These are just a few of the dynamics that may put us at ease or intimidate us, and therefore affect how we treat physicians or whether we even engage in a covenant of caring at all."
Treating other physicians can also trigger feelings of vulnerability in psychiatrists. "In our most open state, we see our own conflicts, fears, faults, secrets, and fragments of shame played out and enacted in our patients' words," Myers said.
Psychiatrists may also respond to their physician-patients by feeling embarrassed or failing to ask important questions, explore in depth what they should, or exercise their usual thoroughness, said Myers.
"We may feel honored or flattered that a physician has chosen us as his or her psychiatrist. Or we may feel defensive, resorting to a cool and stiff manner, humorlessness, eschewing of complex dynamics, psychiatric chauvinism, and biomedical skewing."
Psychiatrists who are wounded healers may believe they have nowhere to turn for help because they fear or are aware of their colleagues' reactions, Myers noted.
"This painful isolation leads to suppression and repression of one's normal needs, contributes to burnout and errors in professional judgment, feeds the temptation to drink and self-medicate, and probably contributes to stress-related illness and suicide. The wounded healer is killed by his or her work. How sad," Myers commented.
He urged psychiatrists to heed the "poignant and sad words of Dr. Mark Lupin, whose physician brother committed suicide in June 1996: 'If given the good fortune to look after a colleague, double your efforts and your skepticism; we may fool ourselves, but we must not fool each other.'"