All doctors ought to go to therapy. As healthcare professionals, we often provide advice to patients on how they can optimize their help, and when advice won’t cut it, we prescribe medications or do procedures. We are exposed to death, suffering, and violence often, sometimes daily depending on our specific job. The COVID-19 pandemic has only worsened these societal ills. If we had a patient exposed to these societal tragedies, we would push them to obtain mental health support. We have to practice what we preach.
There is historical and current precedent that discourages physicians from utilizing mental health resources. For decades, questions regarding physicians’ mental health diagnoses have peppered job applications, board licensing, and credentialing.
This kind of culture has fed doctors to adopt maladaptive behaviors to cope with the daily trauma of taking care of dying patients and dealing with mountains of paperwork, all while trying to optimize earning potential for their employers.
For example, many doctors turn to alcohol, with one 2015 study showing that in the U.S., 12.9% of male physicians and 21.4% of female physicians met diagnostic criteria for alcohol abuse or dependence. In the COVID-19 era, these problems have only worsened.
To be fair, a move in the right direction of destigmatizing mental health in the medical field is definitely occurring. At my medical school, for example, I had various small group sessions focused on mindfulness techniques, with some cognitive behavioral therapy techniques slipped in.
Additionally, my institution has a robust student mental health program that offers psychology and psychiatry services. A student’s involvement in this program is confidential, and if a non-mental health provider in our system attempts to access said student’s medical chart through the electronic medical record (EMR), they would have to “break the glass.” Breaking the glass leads to an audit on one’s activity in the EMR, which is a strong deterrent, as unnecessary access of one’s medical record may lead to termination. However, there is still more work that needs to be done, as even the idea of the urge to look into a colleague’s mental health history should be unfathomable.
If none of the above was convincing enough, a final reason doctors seeking mental health services is necessary is because not addressing trauma and mental illness makes for less effective doctors. Unaddressed mental health issues can lead one to adopt what are called maladaptive or immature defense mechanisms. There are over a dozen well-studied immature defense mechanisms, including projection, denial, splitting, blocking, regression, somatization, displacement, repression, and on and on.
For example, a plastic surgeon may use projection, defined by the American Psychological Association (APA) as a defense mechanism in which “unpleasant or unacceptable impulses, stressors, ideas, affects, or responsibilities are attributed to others,” to push a surgery onto a patient who does not actually desire it.
As another example, an oncologist may use denial, defined by the APA as a defensive mechanism in which “unpleasant thoughts, feelings, wishes, or events are ignored or excluded from conscious awareness,” to keep pushing aggressive chemotherapy and radiation to try to save the patient’s life rather than provide palliative pain control.
There are many different types of therapy (for example: cognitive behavioral therapy, dialectical behavioral therapy, psychotherapy, etc.), but at its core one of the goals of therapy is meant to root out immature defense mechanisms. Even if doctors are resistant to helping themselves, they should go to therapy in order not to hurt their patients.
As someone who has been experiencing the deadliness of COVID-19 from close to the front lines (as medical students, we are somewhat more shielded when it comes to taking care of COVID-19 patients), I believe that all front-line workers have experienced some trauma in the recent year. I certainly have felt this personally, and I am working through it with a therapist.
We need to destigmatize mental health, and we need to love ourselves, at least so we can take the best care of our patients.
I think that my bout with mental health will make me a more compassionate, more competent doctor, and I am grateful that I have been getting the help that I need. I hope others will heed the call.
Adam Lieber is a 4th-year medical student going into emergency medicine.
Last Updated February 05, 2021