I recently had an email exchange with a friend and psychiatric colleague, Dr. Michael Myers, on the topic of professional courtesy. It’s a topic I’ve written about before. However, one of my essays stirred considerable controversy, so much so that readers’ comments turned ugly and unprofessional, and the commenting section on the host website was closed. It seems my op-ed struck a raw nerve primarily among millennials, many of whom were unfamiliar with the concept of professional courtesy and strongly objected to it once it became clear to them that I expected preferential treatment from other physicians for myself or my family members – treatment in the form of discounted fees or quick appointments, or both. Readers considered me “privileged” and “entitled.”
A recent article about Dr. Michael Myers characterized him as a “doctor’s doctor” because he specializes in treating physicians and their families. He noted that the culture of medicine surrounding the treatment of physicians with mental illness and substance use disorders has significantly improved in the past several decades. But physicians suffering from mental disorders are still shunned and marginalized by physicians in mainstream medicine, especially those in positions of leadership and authority, who continue to buy into the myth that if a physician or medical trainee becomes psychiatrically ill, he or she may not be fit to practice medicine, or may not have been cut out for it.
Although mental health stigma has lessened, it persists, and there is a great need for psychiatrists – indeed, for all physicians – to be on guard and available for their colleagues in times of need. Helping physicians recover from mental illness or substance use disorders is rewarding for the individual, the practitioner, and the profession. I regret that I never had a chance to explain this to readers who impugned my essay. I was never given a second chance to tell them how unfair it is that our mentally burdened colleagues tend to be judged by institutional and archaic rules of medicine. I never had the opportunity to remind them that Sir Francis Peabody famously said: “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” And I wasn’t able to appeal to their reasoning by informing them that groomers at PetSmart have more autonomy to book longer appointments for their pets than physicians do for their patients.
I felt vindicated when I read Dr. Myers’ comment that he “grew up in the era of what was called ‘professional courtesy’ – the idea that as fellow professionals, we look after our own. It’s very gratifying work. You can help so many people who are in turn helping others get well.” When Dr. Myers and I presented a workshop (at the annual meeting of the American Psychiatric Association in 2016) for physicians with practice-related PTSD, it generated tremendous interest and a standing-room-only crowd.
Many physicians spoke candidly about their personal experiences with trauma in the course of practicing – either first-hand or witnessed traumatic experiences – and one psychiatrist broke down in tears while telling her story. We asked her to stay afterward to share more of her experience. She had been traumatized by a recent divorce and fell victim to vicarious trauma while treating patients at a Veterans Affairs hospital. We gave her the names of professionals in her area she could contact for further help and possible psychiatric treatment. She deeply appreciated our concern and that we were willing to spend extra time with her. I have stayed in touch with this doctor over the years. She is doing quite well; to ease the pain of her trauma, she left practice for a non-clinical career.
In my recent email exchange with Dr. Myers, he wrote: “There is a middle ground [to professional courtesy]. I think that we can still offer [it] to each other without actually accepting the new patient ourselves. I’ve done this a lot over the years. I call the colleague back ASAP but certainly by the end of the day, explain my situation, then offer the names of one or two colleagues whom I highly recommend who I think would see the colleague (or their family member). If the caller demurs, then I offer to call the folks myself. Obviously, this is time-consuming but I’ve found that simply taking the referral seriously and trying to assist makes the colleague feel respected and heard.”
“Years ago,” he continued, “when I was practicing in Vancouver, I was treating a physician for severe depression, but she also had horrendous migraines. I called one of our local headache specialists, a neurologist, who at that time had a waiting list for a year (remember, this is Canada). He took my call, listened for a minute or two, and said, ‘Have her contact my receptionist. I’ll see her tomorrow night at 7 p.m. If we can’t help each other in our hour of need, then medicine is really f***ed.’ I was so grateful. When I called my patient and told her about the appointment, she sobbed with relief.”
Whether the diagnosis is depression, PTSD, substance use, or some other mental health condition, many of our peers are like the two physician patients described herein: filled with pent-up emotion, ready to burst at the seams, and incredibly appreciative of colleagues going the extra distance to ensure their well-being. Call it professional courtesy or simply old-fashioned medicine – our colleagues deserve no less. Let’s heed Dr. Peabody’s call to the basics of our humanity and restore humility and decency in medicine. We should all aspire to be a “doctor’s doctor.”
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.
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