I know your secrets. I keep secrets for a living.

I know about the eye opener before your shift; the Adderall prescribed for your son that you take in the morning; the Xanax a colleague gave you for upcoming air travel that that you take at night; the near DUI that you got out of by showing your hospital badge, the letters “Dr.” prominent on the left side; your wife who tells white lies about why you can’t attend the retirement party of a colleague’s (“Patient emergency. He has to go to the hospital. I do know you understand.”); or why you didn’t show up for your last appointment with me (“He has the flu. That time of year, you know”).

I haven’t met her, but she has called, leaving concerned voice messages about you. Without saying it directly, I already know her secrets too. I know the shame she feels in covering up for you. I know she has two persistent fears: the fear of leaving you and fear of staying with you.

I know your fears too, and maybe that is part of the reason why you are willing, albeit reluctantly, and inconsistently, to see me. We both, as physicians, know what is on the line. Your career that you were in training for 15 years for, the three children you have, your reputation, your marriage, your practice in which you employ medical assistants, nurses, receptionists, your patients’ care.

Yet, part of you feels that seeking this help is unnecessary and unimportant. And you feel bothered that you are taking time away from your busy schedule. You insist that you keep your cell phone on during our session. As you look at your cell phone, scrolling through text message updates from your staff,  you tell me about a patient that practically made you go to the restroom and take “a few Xanax and a shot.” You describe the case (“a real trainwreck”) as you deflect from sharing your feelings. Right in front of me, I see a train picking up speed and about to derail.

A psychiatrist keeps secrets about infidelity, infertility, insecurity, irresponsibility. Yes, we are responsible to report situations in which someone is at imminent risk of harming themselves, or others, or cannot meet their basic needs for food, clothing, and/or shelter due to mental illness.  However, not much is said about the slow, steady harm one can do to himself or those whom he cares about due to substance use and/or other psychiatric concerns that are not treated.

The barriers to treatment for those who are professionals are particularly difficult because the same strengths that we have, that help us move from emergency to emergency in a busy inner city ER, to tell a patient’s family an unfortunate outcome and be able to see the next patient 30 minutes later, to not divulge every evening at the dinner table the stress we face at work. These strengths, to compartmentalize, to not show weakness or vulnerability, also make it hard to seek treatment. Often the topic of treatment comes up when there are no other options, that is when that treatment is mandated, by the law, the physicians well-being committee, the state medical board, a spouse who is on the verge is leaving. By then, it is less of an empowered decision, and more of an obligatory one and the stakes are much higher.

We are leaders who work hard day after day to take care of our patients, our staff, our families, and our communities. At times, the greatest demonstration of strength, is knowing when and how to get help. Reach out to your psychiatric colleagues or other physicians who are experienced in treating addiction. Curbside us. Ask us what are the latest treatment options are available, such as medication-assisted treatment. Consider making an appointment with a doctor in private practice who can support you confidentially. We can provide you with treatment options and guide you through the next steps.  We know more about what you are experiencing than you might imagine. You are not alone. We know there are other doctors who have been through similar situations and have renewed resilience. We know what is at stake, personally and professionally.

Don’t wait. We are here for you.

Melanie Watkins is a psychiatrist and author of Taking My Medicine: My Journey from Teenage Mother to Physician.  She can be reached at Your Mental Health First, and on Twitter @MWatkinsMD.

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