-“We are watching so much horror —and we must take it with a stiff upper lip?”

That complaint from one of our medical colleagues recently summarizes the sorry spiritual state of most of the health care practitioners that have been taking care of very sick patients in all these interminable months of the COVID 19-pandemic. Most of us are physically exhausted and emotionally depleted with no relief in sight. There are manifold signs that as the non-stop clinical burden takes a heavy tool on us, many are experiencing serious signs of stress overload and emotional/ mental surmenage.

In a great paper, Dr. Clare Gerada stated that the same personality traits that allow us physicians to bear so many clinical responsibilities in grueling work schedules are the same ones that might predispose us to sickness and prevent us from seeking specialized help early on in the process. According to Gwen Adshead, we are:

  1. Perfectionists
  2. Narcissists
  3. Compulsives
  4. Denigrators of Vulnerability
  5. Martyrs

Most physicians can easily recognize a few or all of these traits in our personalities because we have a good esprit de corps that makes us feel “different from others.” We all have a deep-rooted sense of “being special” and our professional identity gets consolidated as we plow through the study-intensive Medical School and the ridiculously demanding work schedules of Post-Graduate Training. It is our armor for survival. In fact all our personal lives get subsumed by the demands of clinical work and the hospital demands replace the ones from family and home; akin to a secret cult we create our own jargon and a new way to see things: the medical gaze.

When we physicians get sick there are external and internal defense mechanisms that usually make us hide the reality and waste precious time to get the needed professional help. You got sick? How come? It can’t be. We , doctors, do not get sick. The others do… Moreover, in all these long months of  pandemic horror and the associated Social Isolation prodded us to necessarily acquire two tricky psychological defense mechanisms: depersonalization and denial of feelings. In order for us to slog through our tasks and still remain operational, we had to “take distance” from the encroaching Death and Despair. The farther apart we moved form the daily horror, the more we duped ourselves into believing that we were somehow “invincible”, which is usually a hallmark of the younger Docs. As we are now used to work in clinical groups with different specialties,  we tend to abhor the idea of “being sick ourselves” as it is like a treason to our healer’s oath to always be ready for big service.  Moreover, if we get sick, someone else will have to pick up the slack with our patients.

Note. Considering that our two references are British authors, we decided to put as featured image this Royal Navy World War II recruiting poster, which was taken from Wikimedia Commons.

Humans need to live in groups and feel a “sense of belonging” to feel fine. For us physicians the primary belonging is to our clinical work and when it is destroyed, then we need a secondary group, preferably with the company of our peers. In another great article, Dr. Gerada discusses the NHS Practitioner Health Program,  which is a very confidential service to discuss and treat the Mental Health disorders of physicians. Finally freed from their masks of empathy, health care practitioners can “spill the beans” in the comforting company of their peers sharing their angst. In the 2008 sample she studied at the time she found that three fourth of cases had Depression/ Anxiety and only a fourth had Substance Abuse problems. She claimed that this represented only a stopover solution and that eventually most of them responded to psychological therapies and later joined other non-medical groups. As the exclusivity of physicians’ privileges have been steadily contested by a more egalitarian approach to health delivery services, there are hardly any physicians’ meeting points like reading and discussion lounges, lunch spaces, etc. We lost the intimate contact with our peers.

She wrote: “it is important that, as health professionals, we engage as patients, participants, and as providers in group work. Part of any strategy to improve retention of doctors must involve creating spaces for doctors to reflect together, support each other and share techniques for remaining mentally healthy.”

In order to get some well-deserved relief from the stress and angst we suffer now, we. physicians, must first take the step of getting rid of our guild-identifying lab coats. Below them, we are simple human beings, notwithstanding all our knowledge. In the re-assuring company of colleagues, including nurses, and devoid of our silly theatrics pour la gallery, we can finally begin to heal.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

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