Dr. Glen Gabbard, a clinical professor of psychiatry at Baylor College of Medicine, has dedicated much of his career to treating physicians. He explained why his physician patients struggle to admit that they need care: “You’re supposed to know everything in a life-threatening crisis. There isn’t room for self-doubt,” he said.
Dr. Gabbard noted that one way doctors reach out for help is through a “curbside consult.” A friend can stop you in the hospital cafeteria and ask for a quick prescription for Prozac. Not only are doctors terrible patients, but we are often crunched for time and can give fellow physicians awful care, too. According to Dr. Gabbard, these consults can be rushed, and some psychiatrists are too quick to rely on their colleagues’ medical knowledge.
This all has helped create an underground market of sorts for physician mental health care. An often unspoken rule: If you must seek mental health care, do it quietly. Find a therapist outside your city who documents only the bare minimum in your chart, pay with cash only, don’t let it be billed to your insurance company. Make sure there’s no paper trail.
As we enter the third year of the pandemic and creep toward one million dead Americans, it’s time for American health care to recognize the toll on its doctors and what it owes. The past two years have been characterized by violent attacks against doctors, accompanied by even longer hours, sicker patients, limited hazard pay and family sacrifices. A survey conducted in the second half of 2020 found that around one-fifth of doctors were considering leaving their practice within two years. Perhaps the saddest part is that the doctors we are often losing are the very ones we need: the gentle ones who you want holding your mother’s hand, the thoughtful, meticulous ones who call you on their day off.
The quickest and easiest remedy to this problem is to eliminate the questions about physician mental health from state licensing applications and hospital credentialing forms. This would require a fundamental shift in paradigm for the medical community. Other solutions include more physician time off, comprehensive parental leave policies and adequate hazard pay.
A former colleague has told me it is ill advised for me to even write this essay. I can feel my palms sweating as I type. But I’d rather be the doctor who confesses all instead of the one who buries the memories of dead children in bottles of bourbon or syringes of fentanyl. This essay is not brave; it is foolish but necessary. It is time we collectively agree that physicians are worthy of the same compassion we give our patients.
We, as doctors, bear witness to humanity’s ugliest and most glorious moments, so it is only natural that we are deeply moved and sometimes disturbed by it all. Acknowledging this vulnerability isn’t weakness. It makes me a better doctor. It is what allows me to hold a patient’s hand under the fluorescent lighting of a sterile hospital in the middle of the night or stroke the congealed blood out of an infant’s lock of hair.