Therapy for Doctors: Physician Wellness = Radical Resistance

Are you a physician or other healthcare worker thinking about starting therapy?  If you are overwhelmed, feeling like something has to change, but wondering whether therapy is right for you, you are not alone. Here are some things to consider.

In medicine, we think of resistance as a problem.  We use the term to describe patient behaviors of avoidance, neglect, refusal, or even aggression when we provide them with recommendations.

We’ve all been exasperated by patients who express an attitude of “I can’t.”  The term is also used to describe phenomena—such as with insulin resistance or antibiotic resistance—in which the systems that are supposed to work and protect us are overcome by pathological mechanisms.  In these contexts, resistance is something to be circumvented.

There is also resistance as intentional acts to protest, disrupt, and dismantle of powers of oppression.  Resistance is a conscientization that things are not the way they are supposed to be, and movement to reclaim power and agency taken by systems of oppression.

You might read this and think, Really? You’re going to use the term “oppression” to describe doctors?  Really.  Are healthcare workers the “most” oppressed group of people in our society?  Certainly not.

One could fare worse than to learn, work, and make a living in healthcare.  Healthcare workers also carry the honor of bearing witness to pivotal moments of humanity: birth, death, sickness, and healing.  But oppression is not an Olympic sport that races to the bottom.  Paulo Freire describes oppression as any situation in which one’s “vocation to be more fully human” is hindered.  How’s your humanity been treated lately?

PHYSICIAN MENTAL HEALTH IS IN CRISIS

Doctors, nurses, even the person at the front desk.  This is not news.  It is plain at every level of healthcare—from the deterioration of medical student mental health, to nursing “shortages,” to the alarming rates of physician suicide—that we are at a brink.

“This is not what I signed up for,” is a refrain I’ve heard countless times from colleagues and clients.  1 in 5 physicians are planning to quit in the next 2 years.

When did healthcare become so burdened with increasing patient acuity, dangerous staffing ratios, litigation, overwhelming productivity requirements, inhumane hours, inequitable compensation structures, and such inadequate support?  Physician burnout is so real; and it doesn’t even begin to describe what you all are going through.  When you are viewed as a resource to exploit rather than a human being, then you will be used until you break and are no longer useful.

There are some rumblings of change.  It has been 20 years since the ACGME changed their resident duty hours.  It helped a little, for a while.  The workflows of medicine and the demands on healthcare workers have undergone dramatic changes since then.

Recently, more residents have gone on strike and used their collective power to establish unions and demand better conditions.  Some of these efforts are succeeding.  It’s inspiring to see these young people working together to imagine and build something more just and sustainable for themselves and the future.  You may look at these movements in the abstract and think “It won’t make a difference,” or, “I can’t do that.  It’s too much.”  There comes that resistance.

THERE IS A DIFFERENCE BETWEEN STRESS AND TRAUMA

Of course working in healthcare is stressful.  No one goes through the MCAT, med school, residency, fellowship, and interacts with sick human beings all day as a form of relaxation.  There is a degree of stress that is necessary for us to think clearly, move decisively, solve problems, and feel fulfilled by our work.  But any homeostatic system requires time, energy, and functioning mechanisms to recover.  Otherwise, it crashes.

There is a tremendous amount of discourse and, frankly, gaslighting that puts the blame of this crisis on the individual.  You need to make time for self-care.  You should have told us you were having a hard time.  Why don’t you join yet another committee to address this problem?  Physician, heal thyself.  I suggest that we are not facing a “shortage” of physician/nursing/etc.  There are plenty of skilled, compassionate, and hard-working folks out there.  We are experiencing a shortage of people who are able to put up with the conditions that make it impossible to provide good care for patients and maintain their own wellness.

THERAPY CANNOT FIX A BROKEN SYSTEM

Knowing the expression or even the etiology of a problem is not a cure.  No amount of deep breathing is going to stop abuse.  No mindfulness meditation will prevent devastating things from happening.  Ibuprofen cannot stop a cancer from metastasizing. Therapy gives us tools, but it alone cannot build a new system.

I spent most of my career working in medical settings that served the most marginalized people in our society.  Poverty, violence, substance abuse, racism—every biopsychosocial factor stacked against them.

I have sat in many exam rooms with patients expressing hopelessness, anger, and resistance to making these changes.  It’s impossible, what’s the point?  After a lifetime of failing and being failed, they had every right to feel discouraged and distrustful.

You have every right to feel the way you do.  But I want to call this form of resistance what it is:

Grief. Fear. Devastation.

PHYSICIAN WELLNESS AS A RADICAL ACT OF RESISTANCE

“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

— Audre Lorde

Audre Lorde wrote this not as a pithy support for face masks and vacations.  She wrote her essay on self-care while experiencing the effects of the cancer that eventually took her life.  This is serious.

As a therapist, my job is to help shift the frame.  A patient with an A1C of 14 cannot hope to reach an A1C of 5.5, or even 12, without time, opportunity, and drastic changes.  A patient whose leg has been amputated cannot expect to walk without significant intervention.

Instead of reaching for a distant or impossible outcome, instead of regretting the irrevocable past, what if our goal was to engage in the process?  In behavioral medicine, I often worked with patients on focusing on the present to identify and do just one, next, good thing.  No one believes you can do it.  The system is not designed for you to succeed.  So we’ll show them.  We will rebel.  We will resist.

Who does it serve to believe that you can’t?  How has that been going for you?  When did we start believing that this much suffering is all that there is?  The difference between a resistant patient and one who resists, is that the former is expected to fail, the second is empowered and believes that something else is possible.

THERAPY FOR DOCTORS: IMAGINE AND CREATE A DIFFERENT PATH

“A revolution that is based on the people exercising their creativity in the midst of devastation is one of the great historical contributions of humankind.”

— Grace Lee Boggs

Therapy is not just about blaming your parents, learning a few coping skills, and venting your feelings.  You can do that with friends, by following the advice of random self-help gurus, or by ranting in online comments sections.  These things also don’t generally produce lasting change.

Therapy is, firstly, a space for you.  A space where you can say things aloud you’ve only thought to yourself.  Express things you felt were too shameful or forbidden without being rejected.  Imagine new ways of being.  Practice what you haven’t tried before.  Examine where you come from, where you are, and where you want to go.  Be creative in the midst of devastation.

Your therapist’s job is to work to understand you.  We are here as a witness, ally, and guide.  Therapy is a way to step more into that human vocation.

The medical community’s stigma holds physician mental health hostage.  It only serves to keep you unwell and exploited.  It feeds the kind of resistance that tells you “There is no point.”  But if you know that something has to change, and nothing you’ve tried before has done much to help, why not engage in the creative process of imagining something new?  What if you chose to resist?

If you have decided that enough is enough, reach out. Dr. Ock founded Ezar Psychology (www.ezarpsychology.com) as a haven for physicians and healthcare workers.  We specialize in therapy for doctors because we understand the life, the language, and the liberation from a vocation in healthcare.  Let’s work together.