Physician Well Being: Healing the Healer

Daniel H. Angres M.D.

 

 

 

This multi-part series of articles will examine medical professionals and addiction in depth. This first article will look at the unique features of physicians in general and physicians and personality styles.

 

Medicine has always been a high reward, high stress occupation. But with mounting fears of malpractice suits, decreased respect from the public, financial worries—including pressure to treat more patients and the need to adapt to technological advances—physicians are under more stress than ever. In addition, physicians are working longer hours, which only compounds these issues. This stress takes a tremendous toll on physicians’ well being, while increasing their risk of psychiatric disorders, addiction, and stress-related medical illnesses.

 

The American Medical Association defines physician impairment as “any physical, mental or behavioral disorder that interferes with ability to engage safely in professional activities….” (American Medical Association, n.d.). Recognition of the impaired physician began to emerge only in the 1970s, and led to the development of physician health programs (PHPs) (Gastfriend, 2005). For decades, these physician assistance programs, like those sponsored by state medical societies and others at the hospital level, have been critical in the identification, triage, treatment, and monitoring of physicians who may suffer from a number of maladies. Greater support and cooperation from licensing boards and hospital medical disciplinary entities have greatly assisted in this process, while a “tough love” approach that helps physicians but holds them accountable has brought these issues into the foreground where they can be openly addressed. Physicians and patients have both been positively affected by these efforts, as physicians’ professional engagement, the quality of care they provide, and their tendency to become overwhelmed all depend on the fulfillment they find in work (Gunderman & Brown, 2006).

 

In the past, addiction was the primary issue with which these organizations dealt, but over the years this effort has expanded. Comprehensive addiction programs specializing in treating physicians and other healthcare professionals have also contributed to excellent abstinence rates and responsible transition to the workplace (Angres, Talbott, & Bettinardi-Angres, 1998).

 

This series of articles will focus on the various mechanisms involved with helping the distressed physician. Addiction will be highlighted, but attention will be given to other areas of potential impairment.

 

Unique Features of Physicians in General

The environmental factors that can impede physician well being include the stress of high expectations, the need to make life and death decisions, sometimes with limited experience, and disruptive life styles due to demanding and inconsistent schedules.

 

Studies suggest that physicians tend to be compulsive perfectionists, a personality trait that has been shown to increase the risk for anxiety and depressive disorders, which are linked to addiction (Henning, Ey, & Shaw, 1998). Glen Gabbard, MD, from Menninger Clinic describes maladaptive tendencies that include difficulty engaging in leisure activities or taking vacations from work activities, a tendency to be satisfied with a low level of intimacy, such as the type between physician and patient, and a need to assume control of uncontrollable events.

 

Difficulty setting limits was also noted, along with guilty feelings relative to the pursuit of personal pleasure. Physicians also demonstrate a tendency to seek marital partners who are skilled at maintaining family relationships and household responsibilities, yet may have difficulty connecting on a deep emotional level with their partners because they are satisfied with a low level of intimacy they typically feel at the workplace.

 

With regard to the medical marriage, social status and financial stability are the rewards, but the bond often feels empty and delayed gratification is common. Future studies may examine the combination of high levels of stress, without a commensurate level of emotional intimacy and connection, and the effect on the physician’s vulnerability to substance use. It has been established that increased accessibility to drugs does increase the likelihood of abuse or addiction in physicians.

 

Physicians and Personality Styles

Knowledge of the common traits of professionals with addictive disorders can facilitate the clinician’s formulation of effective individualized treatment plans. In terms of healthcare professionals, research studies suggest that physicians tend to be compulsive perfectionists. Gabbard used observations from a workshop setting on the role of compulsiveness in the normal physician and related case examples to illustrate the impact of these behaviors on the professional, personal and family life of the typical physician.

 

Maladaptive implications include difficulty engaging in leisure activities or taking vacations from work activities, problems allocating appropriate time for family functions, and a tendency to assume control of uncontrollable events. Difficulties in setting limits were also noted, along with feelings of guilt relative to the pursuit of personal pleasure, which can set up a lifestyle of “delayed gratification.” Participation in a competitive and high-profile profession may serve to mitigate long-term feelings of poor self esteem and to please or impress an internalized parent; similarly, the “impostor phenomenon,” “which occurs when high achieving individuals chronically question their abilities and fear that others will discover them to be intellectual frauds,” also factors in the road to physicians’ addictions (Henning, Ey, & Shaw, 1998).

 

Certain specialties among healthcare professionals have demonstrated increased risk of addiction and drug of choice. In addition to anesthesia, emergency medicine and psychiatry may have higher rates of drug abuse that may be impacted by the baseline personalities of these physicians.

 

There are any number of personality styles, features, traits and disorders in addicted professionals. Career choice, drug of choice, gender, age of addiction onset, trauma, and a host of other factors can influence personality. In addition to obsessive tendencies and the minimizing or indirect seeking of dependency needs in professional populations, one study published in the Journal of Affective Disorders suggested that physicians and lawyers have higher rates of dysthymic temperament and obsessive-compulsive personality traits when compared with the control group of outpatients in various other professions. Needless to say, the causes of practitioners’ distress are numerous, and range from a loss of control over their work spaces to unmanageable workloads and frequent experiences with human suffering and death (West & Shanafelt, 2007).

 

The identification, support and monitoring of physicians who suffer from potentially impairment producing conditions have evolved substantially in the past few decades. A climate of openness, compassion and accountability has assisted both physicians and public they serve and it is critical that this trend continues. Future articles will include discussion of identification, intervention, and assessment of addiction in the workplace; comprehensive evaluation; an integrative approach to treatment; levels of care; specialized treatment for professionals; monitoring and support systems; hospital wellbeing committees; physician health programs; and stress management.

 

References

American Medical Association. (n.d.). Policy H-95.955, Physician Impairment. Retrieved form https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fhtml%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-95.955.HTM

Angres, D., Talbott, D., & Bettinardi-Angres, K. (1998). Healing the healer. Psychosocial Press.

Berge, K. H., Seppala, M. D., & Schipper, A. M. (2009). Chemical dependency and the physician. Mayo Clinic Proceedings, 84(7), 625-631.

Cicala, R. S. (2003, July). Substance abuse among physicians: What you need to know. Hospital Physician, 39-46.

Gastfriend, D. R. (2005). Physician substance abuse and recovery: What does it mean for physicians—and everyone else? Journal of the American Medical Association, 293(12), 1513-1515.

Gunderman, R. B., & Brown, S. (2006). Viewpoint: Enhancing the professional fulfillment of physicians. Academic Medicine, 81(6), 577-582.

Henning, K., Ey, S., & Shaw, D. (1998). Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Medical Education, 32(5): 456-464.

Lutz, A., Brefczynski-Lewis J., Johnstone, T., & Davidson, R. J. (2008). Regulation of the neural circuitry of emotion by compassion meditation: Effects of meditative expertise. PLoS ONE, 3(3), e1897.

Schernhammer, E. (2005). Taking their own lives—The high rate of physician suicide. New England Journal of Medicine, 352(24), 2473-2476.

West, C. P., & Shanafelt, T. D. (2007). Physician well-being and professionalism. Minnesota Medicine, 90(8), 44-46.