Heal Thyself

You cannot reach your full potential as a healer if you do not look after yourself—your physical, social, and emotional well-being. Many physicians I know seem to wear their lack of routine health care as a badge of honor, as if taking time out and having another physician help you with your own health is in some way selfish. It is quite the contrary; it is foolish not to. 

The practice of medicine is demanding, and the toll it can take on a physician is significant and is not to be neglected. Dr Theodore Woodward notes in his book, A Time for Sentiment, that “the likelihood for suicide, like addiction, is high in physicians.”¹ He explains how “this is perhaps understandable when one considers the intense need to acquire knowledge, the drive to excel, and the intense worry about decision-making and its consequences.”

Unfortunately, too many physicians—and perhaps their families—go without the same good medical care they diligently recommend and provide to their patients. While fewer physicians smoke cigarettes today than in previous years, many do not follow through on important preventive medicine strategies (eg, colonoscopy or hypertension screening). Missing work because of a preventable illness or compromising your ability to deliver care because of disregard for your own health only denies your patients proper access to health care.

I have known doctors (including a gastroenterologist) who were diagnosed with advanced colon cancers due to lack of proper colorectal cancer screening. I know physicians who care for adult patients, but do not know their own blood pressure or cholesterol level. When you care for yourself or loved ones, it becomes difficult to draw the line and even easier to overstep those drawn by professional medical societies and ethics committees. When you or a loved one is sick, seek out another physician for treatment.

Seek Advice

One summer, I served as an “able-bodied” seaman for the Association of Maryland Pilots. One night near Norfolk, VA, I assisted a Chesapeake Bay pilot to the ship’s ladder at 2 am, amidst gale-force winds raging up the bay. As the 30-foot launch heaved up and down alongside this inbound container ship, I had difficulty tying the bag to the rope needed to carry it topside. We both were in danger of going overboard. The senior pilot urged me to look out for myself while performing the dangerous tasks required by this job. He yelled to me through the wind, “One hand for yourself and one hand for the ship.” 

This maritime adage applies to us in medicine as well. Healers should not feel guilty about looking after themselves, even if doing so comes before delivery of care to their patients. By being healthy ourselves, we may live another day to take good care of our patients and make sure the care we provide is the most effective and successful possible. 

My advice is that healers should find someone they have confidence in and seek their care. Be it preventive or treatment, you have the right to receive expert care. Your patients deserve to have you at the peak of wellness, so that you can best serve them. Too often, physicians—being in conveniently close proximity to medical care—will self-diagnose and treat themselves. Even worse, they extend this care to their family. Although most of us do this to some extent, it starts us down the path to crossing those lines. In treating our loved ones, we are unable to be objective and less likely to be as thorough. The care we provide to them is skewed by our connection, and often it is substandard to the care provided by someone else. The best way a physician can heal himself is to seek the advice of a trusted healer and follow it.

Another important way to look after yourself is to realize that in any service industry, including health care, you may find yourself in threatening situations. Fortunately, this is rare in most fields of medicine but as a public servant, we may sometimes be confronted with people who look to harm us. 

A Hard Lesson

Some patients are overly friendly because that is their nature or how they express appreciation. Other patients are overly friendly because of mental illness. While I admire the intent of physicians who give out their personal contact information so patients may easily reach them, I admit to doing this rarely because I have seen firsthand how mental illness can distort a patient’s interpretation of reality and social boundaries. 

I was stalked by one of my patients, and I wouldn’t wish this experience on anyone. I tell you this story for one reason only: I hope you never have to go through what I went through.

Many years ago, I saw a patient in my private practice for a rather straightforward complaint and recommended an appropriate standard of care evaluation and management plan. This was followed by several back and forth interactions with this patient that grew increasingly bizarre and I became concerned. I couldn’t understand why I was receiving single-spaced, multiple-paged letters by this patient alleging mistreatment and malpractice. I was threatened with being reported to several oversight agencies for my bad doctoring. I felt then, as I know now, that I had done nothing wrong. 

Thankfully, I had the foresight to discharge the patient from my practice in proper legal format (ie, in writing, with 30 days’ notice, and offering to forward medical records to another physician upon receipt of a written directive to do so). Nonetheless, the patient continued to stalk me by phone, mail, and in person, informing me that the discharge was not accepted until I righted the perceived wrong that I had done. I began to fear for my family’s safety. 

The nightmare didn’t end with personal intimidation. I was reported to the State Board of Physicians, a federal office that dealt with the rights of those with disabilities, and my state medical assistance office. I sought the counsel of an attorney, who said I was describing what would qualify as harassment based on the state law and was advised to get a restraining order.

I reflected upon what I had learned in behavioral pediatrics, as I thought this person’s behaviors were childlike and at a minimum, represented a type of acting out. I did not know then with certainty that the person was certifiably mentally ill. I remembered that if you want to extinguish a certain behavior in a child, it is better to not attend to the behavior but rather to ignore it. I decided against pursuing the restraining order, as I thought it might add fuel to the fire. Two months later, this patient was admitted for his first paranoid schizophrenic break, which was later followed by many more psychiatric hospitalizations. In retrospect, my patient’s abnormal pursuit of me represented the early signs of psychiatric illness. This experience taught me an important lesson: Physicians, protect yourself.

Personal Safety First

Protecting yourself is not self-centered but represents good medical practice. The example above is extreme, but there are many ways to avoid or abate dangerous situations—eg, sit near an open door when you perceive a patient to be hostile or make sure to have an attendant of the opposite sex present when performing sensitive parts of the physical examination (eg, the pelvic or genital examination). 

You want to be careful when examining an acutely psychotic paranoid schizophrenic patient. Be careful not to be perceived as threatening, and, if need be, simply stop the exam and walk away. I declined to examine a patient like this when requested to perform the admission exam at a local psychiatric hospital, diffusing the situation to avoid the possibility of physician harm. Instead I spoke with him in the hallway, where I could exit easily. During the exam, I was struck by how paranoid he appeared. After asking him if I may listen to his back, I noticed his spine straightened and he became very rigid. Something told me that I should be frightened, so I concluded the exam and thanked him for his time. The next day, I was asked to attend to the same psychiatric hospital’s staff psychiatrist, who suffered a stab to the neck from the very same patient. She had come too physically close to this patient and was unable to protect herself when he snapped. 

I believe there is no greater satisfaction than to serve, but the wise healer recognizes that he or she must be in good physical condition in order to serve well and is aware that there will be rare instances when you must be mindful of your own personal safety.

Richard Colgan, MD, is a professor at the University of Maryland School of Medicine in Baltimore, MD, and the vice chair of medical student education and clinical operations in the Department of Family and Community Medicine. He is also the author of Advice to the Healer: On the Art of Caring by Springer. 

Reference:
1. Woodward T. Make Room for Sentiment: A Physician’s Story. Baltimore, MD: University of Maryland Medical Alumni Association; 1998.

Further Reading:
Angres D, Talbott GD, Bettinardi-Angres K. Healing the Healer: The Addicted Physician. Maddison, CT: Psychosocial Press; 2001.