As a mental healthcare professional, I work with a variety of interdisciplinary teams collaborating on best treatment for complex patient co-morbidity which often include mental health and medical concerns. Every so often I get pulled aside for a personal or family-related consult from attending healthcare providers. The conversation often starts with, “I just have a quick question…”
The home-life stories I have frequently listened too, which healthcare providers (including physicians) encounter after their full days of dealing with their patients’ crises, are both heartbreaking and inspiring. I join them in the uncertainty on how to make it better and feel sadness in the often expressed fear of being judged by those around them as unprofessional due to this significant life problem. However, I also feel awakened by their courage to reach out and trust someone right now to share their pain and not be alone for at least one moment in their workday. In the fast paced healthcare system, where the paperwork on complicated patients often takes longer than the allotted 5 minutes between patients and at times piles up to the point where we have to bring our work home with us, it makes sense to me that our home life also sometimes comes with us to work. These personal struggles and stories I have heard from healthcare providers might offer a glimpse behind the white coated veil separating patients and doctors for the sake of objectivity. In short, often what’s happening at home for our providers has the same themes as the personal stories patients share. We all seem to be seeking skills and new ways to creatively respond to the relationships that grow and infuriate us in the best and worst ways.
Recently, instead of being pulled aside privately after our interdisciplinary team meeting, a physician brought up in front of the team that a friend and fellow physician was in trouble. She told us that this colleague she had known for years was being accused of a crime. At its heart, the story is one of human relationship, describing explicitly and between the lines many years of coping through misery, survival, and suffering. As people (in healthcare and the public) rally to support this doctor (and/or judge her), I am reminded of what we all have in common here. Forgive the simplicity, but it is our humanness.
As healthcare professionals we are placed on a pedestal as experts and given privileges that come with risks. Our judgements have more long-lasting impact than other professions (e.g., the clerk at the checkout counter) on the lives and well-being of those we care for, and so we are held to a different standard of self-awareness and ethical behavior. Our professional analysis is expected to be informed by years of training and discipline and the labels and recommendations we give (or prescriptions in her case) often cause a cascade of decisions and reactions on what to do next to alleviate suffering. Ideally, these decisions result in better health and well-being, but sometimes it seems no matter what we decide, they do not. However, in healthcare the white-coated veil we have been trained to place between our personal and professional lives, with the goal of objective knowing, is not so black and white (legally or in real life).
While issues raised in this story are profound and complex—including substance abuse, domestic violence, prescribing rights, and personal and professional ethics—the connecting piece between all of these is that as healthcare providers we are first human beings and need support from community to make the personal and professional decisions that hold risk. Noticing my responses as someone who relates to her story from multiple roles, I feel waves of sadness, anger, confusion, and I know that I am likely to turn to judgement and tell myself I could have done it differently. I want to protect myself from having this be my story too.
Did she have access and exposure to mental healthcare without her personal struggles being judged in her professional world as reflecting incompetency and weakness? Looking at humanness beneath the objectivity we so often dress up and embody as professionals of healthcare, I wonder: How do I seek support from my colleagues when I feel myself lost in these grey areas and need help? From being a student of social psychology, I know that our culture has a hunger for heroes and villains and we look for and label those around us often with just such extremes. While hero worship of our physicians and healthcare providers can help us feel safe and confident that we are being taken care of by and working with extraordinary healers, I have also seen how easily we can villainize the same individuals when we are faced with what we judge as their mistakes. This reactive pattern in society increases dichotomies between physicians and everyone else (also known as defensive medicine) and can isolate our providers from their humanness by non-verbally cuing them into believing that feelings like fear, confusion, and sadness are unacceptable for their level of intelligence or expertise. This could understandably lead to the hushed and rushed sharing and advice-seeking I see all too often. There is a pervasive belief in healthcare that consulting with colleagues at work or seeking counseling separately will somehow be seen reflecting weakness and incompetency.
How did her community, now rallying behind her, not feel that something was amiss when connecting with her on a daily basis? How have I participated in the culture of shaming and silencing healthcare providers in their humanness both as a patient and healthcare provider? How many of us have looked away from healthcare providers like the one soon to be on trial and hoped they get their life together soon? Did we ever realize that we as a community contributed to this story? How were we so blind to the human pain and helplessness that this physician was struggling with for all these years? I am reminded that our non-verbal communication largely outweighs anything we say, and this painful story reinforces the importance of feeling curiosity as I greet my colleagues on a daily basis. I recommit to consciously pausing in my work, making eye contact, and listening for an answer when I ask the customary question at the beginning of the workday, “how are you?” An even more uncomfortable question I must ask myself is how am I modeling that this is a safe environment to give a genuine answer by revealing my own struggles on occasion and seeking support with those I hope will reach out to me?
Did she have a work-life that had enough balance and support where she had the time to leave and seek support professionally? What I admire about the physician who named this heartbreaking personal and professional story in our treatment team is that she is doing what we all need to do more of—breaking the silence in our professional culture of compartmentalizing feelings and denying that we are human. Instead she was naming the distress and questioning we all feel somewhere inside of us when we see someone we relate too and care about make decisions that hold pain and risk. The physician accused of a crime was coping with someone struggling with substance abuse at home. Our knee jerk response as practitioners of professional boundaries and quick-thinking problem solving could be the same as we often speak to our patients, “stop drinking,” “Stop risking,” “stop caring,” and yet the cumulative research on addiction is showing that instead of the cure being abstinence (as many laws and treatments require and promote), the opposite of addiction is human connection. Maybe as healthcare practitioners we are addicted to our objectivity at the expense of our relationships with our humanness in ourselves and each other.
This brings me to using this medium of public discourse to reflect on the best of what I’ve learned in the process of practicing healthcare which, as many providers know, never really gets put away completely when I leave work. In my personal life I am sometimes approached with complicated problems from friends and family that ideally belong in a counselor’s office, and yet on a moment to moment basis, I know that going to counseling is not always the first step or support needed. Meanwhile, I get to offer my best humanness and practice empathy with listening and responses that convey caring such as, “I feel sad and can only imagine how hard this is!” I can practice curiosity, “What do you need? How can we find you more support?” Finally, I can remember that as humans (healthcare providers and patients alike) we all have moments of confusion where the darkness of our lives envelopes us and we can’t see any other choices. I can choose to be one who holds light (through care and curiosity) for others, and also model asking for support when I am struggling with my own heartbreak and sadness. Even though the reactions and advice we sometimes give (as professionals and human beings) might not be enough to change what is going to happen, it is how we react, reach out, offer, and ask for support before the crises (which inevitably strike us all at some point in our lives) that allow for building connection and community during and afterwards.
My final reflection is that as a provider I often feel the expectation requiring me to do something with/for/to my patients repeatedly whether they agree with me or not: fix them, help them, and rescue them (often from themselves). When we are practicing this fear-based reaction pattern in the workplace, how can we not come home and attempt to do the same? In the mirror of this physician’s tragic story, and her friend’s courage in naming the pain of what is often left unsaid, I challenge myself and all of us to carry this conversation in healthcare forward on how we are embracing and acknowledging human in each of us. While the struggle with the greyness and uncertainty in our relationships will likely never go away, maybe our curiosity could turn towards the colleague sitting next to us typing away at those never ending patient notes and help us all begin looking at how we can return to compassion in our healthcare community and recreate a humane working environment where it is not only welcomed but also considered normal to say “I need support, and I’m afraid…”