Unwell colleagues need understanding, support

Medical Post
Helping Hand Column, September 26, 2006

Reluctant to seek help, MDs who finally take care of themselves fear insensitive reaction of peers

It is September, and the leaves are just starting to turn. People are back from holidays and have returned to work or school. But I can’t help but think about those who are not returning—colleagues who are not well and are required to take time off. This is an amazingly difficult time for them.

It is hard for doctors to acknowledge when we are not doing well and need help. It is hard to recognize signs and symptoms of stress, burnout, depression, anxiety and addictions in ourselves. It is even harder to reach out, beyond the stigma, the fears and insecurities, the guilt and the self-reproach, to get help.

For some, getting treatment requires just a minor adjustment of their schedule to include therapy, or medication. For others, it requires a much greater adjustment, as they need to take time off. This is never a light decision—either by me as the treating physician, or by the physician-patient who has huge responsibilities in an already under-resourced field.

By the time colleagues come for help, they have often waited longer than the average patient and are often more ill, with severe symptoms. Admitting their difficulties is a huge step and there is a great sense of relief at not having to act as if all is fine.

Despite this relief, it is rare that colleagues accept the advice to go off work easily. There is the initial guilt of having gotten to this point, “for having allowed it to develop,” and being weak and having failed in some way. Then, there is the guilt of having to leave their patients and practice at the last minute, and of adding to the burdens of colleagues already working at maximum capacity but now required to do more.

There is also fear of not being believed, since there is no visible or tangible disability such as a heart attack, cancer or a broken limb. Doctors needing to take time off fear being judged by colleagues as weak, faking it, “not cutting it as a doctor,” being limited in their future career or of being ostracized.

Yet, even after acknowledging that they are very ill, not functioning and finally agreeing to take time off, most doctors do not just go home. Quite the opposite—they reach deep within for the “final push” and squeeze out the last remaining ounce of energy to clear their workload, plow through booked appointments and complete paperwork before they leave. This sense of responsibility is understandable, but makes their going off work even harder to understand for peers.

The first week off is often spent in a state of shell-shock, amazed that all they can manage is to eat, nap, sleep. Then the real work begins—a time for reflection on what happened and what needs to be modified. They do not know how to relax and will need to learn. Self-nurturing is not second nature. There is the need to switch from taking care of others to taking care of themselves. Doctors feel they should look depressed while out in the community, to justify their absence; that it is wrong to have fun or to do something enjoyable. Yet, this is exactly what they need to (re)learn. Nowhere is it written that the treatment for depression is to lie in bed with the covers pulled up over one’s head.

It is often painful to deal with the varied reaction of colleagues. There are those who are kind and supportive, but it is not easy for us to accept this care. More difficult are the less caring responses. Some colleagues say nothing, do not contact them and effectively ignore them. This silence may be an unconscious sign of discomfort, but it is perceived as uncaring and dismissive. In one hospital department, a doctor was hospitalized with a heart attack. His colleagues visited him daily and sent cards, notes and flowers. Another colleague was hospitalized in the psychiatric unit with severe depression. No peer sent a note, a gift or came to visit.

Some responses are more overtly lacking in understanding or empathy. One doctor, advised to go off work, returned to her office for the “final push.” As she was finally leaving the hospital on Friday afternoon, a colleague casually called out to her, “Good bye. Have a good time off. . . . It must be nice!” Some doctors have even been told their illness is their fault, that they deserved this, they created it, that it was avoidable and self-imposed, or even that it was the result of greed. Similar problems often crop up on the return to work.

The medical profession needs to nurture the development of a compassionate understanding that allows open discussion, early recognition of illness and supportive collegiality.

Mamta Gautam is an Ottawa psychiatrist who specializes in treating physician patients. If you have a question you would like addressed in this column, please contact Dr. Gautam at mgautam@rogers.com. Please include “Helping Hand” in the subject line. All inquiries will be confidential. Your questions will not be replied to, but may be selected to be answered in this column, which is intended to be educational, not therapeutic.