I had the pleasure of sitting down with John Tamerin, M.D., and Mike Myers, M.D. to discuss the psychiatric needs of mental health clinicians. Dr. Tamerin has a private practice in Greenwich, Connecticut and is Clinical Associate Professor at Weill Cornell College of Medicine in New York City. He has been running a support group for those living with (and affected by) mental health conditions for over twenty years. Dr. Myers is a national expert on physician health, has authored 8 books and is Professor of Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry and Behavioral Sciences at SUNY Downstate in Brooklyn, New York.
Dr. Myers moderates the session and introduces the discussion by saying
“The sad irony is that many (physicians) do not receive the care that they so sefflessly give to others and that they need and deserve for themselves.”
When I finally admitted to myself that I had bipolar disorder and was clinically stable, I made the decision to disclose my diagnosis. I did so in a very public way at the International Conference of Bipolar Disorders. After I approached the podium, the first words I said were: “I am a psychiatrist and I am also a psychiatric patient. I have bipolar disorder.” It is uncommon for a physician to disclose their mental health diagnosis.
The reaction of my patients
When I did disclose, I was still practicing. My greatest concern in doing so was not the reactions of family and colleagues. I was worried about what might happen if my patients were to become aware of my diagnosis. I hoped that I hid my symptoms from patients over the years, but can I be sure this was the case? I believed that for some patients, knowing my diagnosis wouldn’t matter at all. Others might see me as empathic since I was living with a psychiatric disorder. But I had to conclude that my care of some patients would be impacted in a detrimental way. I was sure that some patients would be angry that I had withheld this information and would terminate their care with me. This was a sobering realization since I took the Hippocratic oath as a physician to “First, do no harm”.
Why I disclosed
I was unmedicated for most of the years that I practiced, so there might be those who believe that I should have taken medical leave each time I cycled up or down. Or, perhaps there are those who believe that I should have left the profession entirely. But given the prevalence of mental health conditions within the physician community, I don’t think the best course is to exorcise all of us who have been unwell. I recognize that other clinicians might have made a different choice than the one I did. Despite my certainty that I would negatively impact the treatment of some patients, I made the decision to disclose my diagnosis for two reasons. First, it was an act of self-healing. Perhaps selfish on my part. Second, I thought there might a greater good for my fellow clinicians in the medical community to foster a conversation about physician health. If I had to do it over again, I would make the same choice.
Reasonable people may have different views about whether clinicians who have psychiatric disorders should practice. This is fair to question. I would suggest that these are exactly the kinds of conversations we should be having. We need people of good will to come together and speak about these important issues. Then we can find common ground in our efforts to balance caring for our colleagues in need and, at the same time, placing a premium on delivering excellent care to our patients.
What do you think about my decision to publicly disclose my diagnosis?
The mental health of our nation’s doctors is not so good. Physicians are worried and depressed. The prevalence of psychiatric disorders amongst clinicians and medical students is depressingly high. The pervasiveness of clinician burnout has caught the attention of many in the medical community. But most doctors keep their mental health symptoms secreted away. They understandably worry about professional consequences if they do not. As a doctor living with bipolar disorder, I have shared my diagnosis publicly. I did this as an act of self-healing but also because I wanted to start a dialogue about a topic viewed as taboo.
Doctors fear losing their medical license
In whispered confidential conversations with peers, I have come to see that many suffer in silence. They’re afraid of losing their license to practice medicine if their diagnoses were to become known. This worry is not far fetched. Currently, each state has a board that licenses physicians. Many of these states ask unfairly broad questions such as “have you ever been treated for a mental health condition”? So, any doctor who might have had a panic attack a year ago, for example, might feel that they’d be putting their vocation at risk if they were to divulge this. It’s no wonder that practitioners go into hiding. However well intentioned, the current system is misguided. In this status quo, no one wins. We can all agree that doctors don’t want to feel depressed and patients don’t want depressed doctors. All this is particularly frustrating because treatments are so effective and doctors (and non-doctors) can be their usual highly-functioning selves when they receive care.
Physicians are being sacrificed
It’s important that we have dialogues to disrupt this unhelpful status quo. State medical boards have a duty to oversee patient care by monitoring clinicians. Understood. But, In pursuit of this laudable goal, physicians are sacrificed. It’s possible to provide excellent patient care and have healthy physicians at the same time.
The simple answer: courage and conversation
Why can’t the powers that be sit down with medical community leaders and find common ground? This is not beyond our capacity. Have I placed my medical license at risk by acknowledging that I have bipolar disorder? Perhaps I have.
If my state‘s medical board tracked me down and informed me that my license to practice medicine was at risk, I’d hope that we could have a conversation. I’d ask them to explain how they believe the current system is helpful to doctors and patients, let them know that my peers are avoiding treatment and suggest that we work together to be a positive force so doctors can stay well. And what if despite these efforts, they suspended my license anyway? If so, it would be a chilling message to those who are in hiding to remain out of view. It would be a depressing coda to my story which has been one of success and triumph-a physician with bipolar disorder, well treated, stable and highly functional. Most important, I’ll think of my worried, depressed colleagues who are committing suicide at rates that should concern us all.
Physicians are people of good will, dedicating their lives in the pursuit of healing others. The challenge is that many doctors neglect their own health, and consequently they struggle to help their colleagues in need. If I were to write a letter to doctors as a peer with bipolar disorder, it would read something like this:
My dear peers,
Your colleagues are in trouble and need you more than you might imagine. Ask yourselves how you might be more helpful to those of us who are currently unwell. We must do more to make their journey one that is safer and easier for them. We all march forward when those who have been suffering in silence speak out. But that is only half the solution. It is too heavy a lift for those of us with mental health conditions to push this heavy rock up the hill by ourselves.
Share your thoughts
Please don’t underestimate how impactful your words or a hug might be. I spoke with a colleague years ago, sharing my story and her response was simply to give me a hug. It was exactly the nourishment I needed. For any given clinician, it can be daunting to know how to shift the current status quo of secrecy and silence in regard to the prevalence of psychiatric disorders within our medical community. I would ask you to merely look in front of you each day. You are skilled practitioners, perceptive in assessing those of us who are unwell. You know who is struggling.
Remember, we change the culture of secrecy one conversation at a time. Dare to ask your friends and your peers how they are. Most of the time they will welcome this because they know it comes from the heart. Have the fortitude to find your voice and in response, they will too. If we don’t put our compassion into words, our silence can be heard by those who suffer as “you do not exist.” We may ask you at times, to lift us up. Please, consider using the decency and concern that you possess. You have chosen a vocation in which you heal others, so train your heartfelt focus toward healing those of us in need.
The topic of physician health is increasingly rising to the surface in our community given the concerns about physician burnout and the evident morbidity and mortality that afflicts us. Given the conversations we are now having (and my good friend and colleague who gave me a hug), I have faith that we can summon our courage and shift the current avoidant stasis You colleagues and friends are waiting for you to do so. Please, reach out your hand.
My favorite scene in the Wizard of Oz is when Dorothy opens the door in her just-landed house in Munchkinland, leaves black and white behind and steps into a new technicolor world. The colorless view she had wasn’t going to bring her home. This is the same fallacy of either or thinking in physician health.
I avoided psychiatric treatment for my bipolar disorder for far too many years and during that time, I continued to practice medicine. Some will view that decision as controversial or problematic. Some will believe that I should have stopped treating patients all together. But given the numbers of clinicians who have psychiatric conditions, I don’t think exorcising us all from the field is the way to go.
The fallacy of either or thinking
We all agree that clinicians shouldn’t practice when symptoms impair their capacity to do their job. But, we view this issue through an all-or-nothing, dichotomized lens: we feel that we must either overemphasize physician health at the expense of patient care or (the current state of affairs) place a premium on delivering care at the expense of physician mental health. We can see no middle ground. But, I believe that we can find ways to shift our black-or-white view. We can deliver excellent clinical care and tend to ourselves simultaneously. Our current mentality perpetuates a stasis where our colleagues suffer in silence or depressingly, end their lives. It is unacceptable to continue to ignore our peers by refusing to find middle ground between the all and the nothing.
Living in a world where we feel we must choose to either sacrifice our patients or ourselves perpetuates the unacceptable status quo currently embedded in the medical community. Here’s the important thing: When Dorothy opens the door, she finds more than a world of color. She finds those of good will who walk with her as she journeys down her yellow brick road. Let’s join hands so we can take care of both our patients and ourselves. Let’s travel to Oz together. If we do that we can eliminate the fallacy of either or thinking in physician health.
I wonder if any readers have struggled to take care of themselves?
I grew up watching Superman. Impressive man…leaping tall buildings and all that. Just the kinda thing a young kid wants to do. Fast forward. During my psychiatry residency, I was having periods of clinical depression. It was weird to awaken in the morning with endless loops of suicidal ideation in my head and then that afternoon, hospitalize patients with the very same symptoms. But, I told no one.
Stigma about professional consequences
Too many physicians living with psychiatric disorders shun treatment. They pay a terribly high price in morbidity and mortality. The rate of physician suicide is way high. We can understand how doctors avoid care given all the worries about professional consequences. Stigma against doctors is quite prevalent. Examples of professional consequences include collegial disapproval and concerns about the potential impact on medical licensure. These are the reasons that doctors eschew treatment, and these fears are real. Engaging in care and public disclosure are fraught with stigma. This stigma arises in a status quo of secrecy and silence deeply ingrained in the medical community.
Our culture lauds physicians who are uber-competent and stoic. However, we expect practitioners to soldier on despite the unacceptably heavy burden they carry. Similarly, we like our doctors to stop speeding bullets. But the intense pressures to perform can have the unintended effect of battering the psyche. So, it can feel like kryptonite is all around us, every day. Because of this, many suffer in silence. “Physician, heal thyself” becomes advice unattainable. So, care givers have difficulty training our healing focus on ourselves and on our colleagues in need.
My antidote: humanity
Currently, doctors can disrupt this stasis of demoralizing shame and challenge the destructive, avoidant status quo. After many years of trying hard to be Superman, I have finally arrived at a place of acceptance and well being. I found a way to navigate a pathway from being a care giver to becoming a care receiver. I did this by recognizing and integrating a healthier and humane inner story line.
My humanity became the essential vehicle for my recovery. So, mine is a story of success and provides a template for other doctors. It’s also a template for anyone who remains locked in the grips of untreated psychiatric disorders. I created a pathway to wellness and leaping tall buildings and to stopping speeding bullets What exactly the opposite of what I needed to do.
Do you have a Superman story? Let me know
If you are a doctor and would be interested in knowing what i would say to you, please click here