Locums can be a very challenging space, at least for anesthesiologists. Environments are frequently disrupted. There is often animosity between clinicians coping long-term with turmoil and inadequate staffing, and the temporary locums who fill a gap and are often paid substantially more for their intrusion. In anesthesia, the quality of the relationship between clinician and the total environment is essential. This includes nuances of the culture, scheduling structure and expectations, anesthesia colleagues, surgeons, nurses, and administrators. And these can be very challenging environments within which to forge those connections that facilitate consistent and excellent patient care. Locums can be looked upon with suspicion, often do things differently, and sometimes have a very difficult time assimilating the culture of each unique assignment. This is a place exponentially more difficult to navigate for anyone struggling with self-doubt or tendencies toward isolation.
The initial drive to reconnect with my young adult interests in mental health was forged in my locums experience. Across locations that I worked, I met interesting people in a potential space, not quite integrated—both wanderers and those upon whose working space we intruded. I met strong personalities with unique talents and stories. I met a core group of people with tremendous integrity and tenacity. And I lost three colleagues in that environment, two of whom I counted as friends and one I did not know well before he died. Looking back with what I know now, I am deeply saddened at the loss of life—infinitely preventable.
We work in silos, all carrying, to an extent, experiences which make us in some ways more alike than not. It is a common belief that others don’t share undermining thoughts and feelings inadvertently exacerbated by the emphasis of our education and training. Striving for excellence not tempered by attention to inevitable human fallibility risks cultivating a perverse responsibility for perceived failure. This is at odds with the reality of our chosen profession. This frequently presents as ruminating on personal shortcomings and striving for unrealistic perfection. It can worsen fear of conflict, a need to please, and certainly subjugates rather than helps us face our fear of hurting our patients. None of this productively serves the emotional repercussions of being involved in the critical complications we invite into our lives by shouldering this profound responsibility in our medical profession.
In a keynote talk on physician well-being, which I was invited to give, I introduced some of the tenets of positive psychology and why these alone are inadequate to the task of addressing well-being in our environments. This is a modality dedicated to thriving in a healthy environment but does not address the fundamental contributors to the physician struggles identified in numerous studies. I elaborated those contributors, some commonality of impact, and focused on well-developed approaches, as well as perspectives of a psychotherapist immersed in our evolving work environments.
Peer support is a growing concept which harvests interpersonal connection in among the most challenging of realities that we take on, consciously or not, by choosing to be physicians. For every endeavor to help a sick or injured and vulnerable person, we risk hurting them, because none of us are perfect. To be able to embrace this reality as a physician is a lifelong journey with varying levels of awareness versus pretending to have total control with our rituals. And when it happens that a patient comes to be injured by our hand, it is critical to know that one is not alone. Isolation is a deadly place to grow rumination and self-doubt, recrimination, and despair. Peer support is a direct antidote, connecting people in shared experience, bringing each other along on a path that none of us would choose. It can make the difference between despair and thriving. Medical environments are in desperate need of integrated, structured, and protected experiences of authentic emotional and compassionate connection to foster well-being. Ideally, these experiences should be available and engaged long before a need to process adverse outcomes. Also essential to this forum is a space in which to nurture a sense of agency to modify the environments that contribute to our collective ills. All of this is reflected in our published high rates of burnout, depression, anxiety, and, like my friends, completed suicide.
My friends, to the best of my ability to mind-read, did not complete suicide because they were involved in patient care complications. One was profoundly lonely, the other profoundly depressed, a third person was mired in drug addiction and died of an inadvertent overdose. All three deserved helping attention. They showed up to work, engaged the environment with competence, provided excellent care of their patients, and for the most part got along. As for so many, their internal struggles were deeply private, and it was stunning to hear the news of their untimely deaths.
While peer support as a concept mitigates isolation, and sometimes feelings of being uniquely insecure or flawed, and feeling self-persecutory when bad things happen, it is also particularly poised to identify when counteracting isolation is just not enough. This is a not infrequent occurrence due in part to the environments in which a physician is forged—high-stakes, sleep-depriving, lonely, arduous, unrelenting, unforgiving, and sometimes deeply punitive in both internal and external voice. It helps to learn that others feel that way too, that others share in some common experiences. It is less lonely and deeply validating. And sometimes it is enough to reframe occasional lies of the internal voice and negative contributions of the external voices in our working environments. But it is a critical skill to recognize and feel comfortable nudging people towards deeper exploration in the hands of a professional for the many who cannot shake their despair, anger, sense of helplessness, or increasingly nagging self-doubt.
None of these troubles necessarily rise to the level of medical diagnoses, none of these are indicative of character flaw, but rather reflect a reality of being human in a high-pressure profession. And all deserve the attention of an individual committed to understanding and bringing awareness to both the how and the why not addressed by peer support. How they came to be where they are, that they have agency to enact change, that they do in fact have the inner resources to navigate this, and how to connect with these often-elusive personal truths. Sometimes this involves wrestling with internal voices emanating from a structural framework built on perverse assumptions that need deconstruction. This is where a simple reframe is inadequate. This is where a focused root cause analysis moves towards understanding how a thought that distorts contemporary circumstance may have once served to protect in a long-forgotten or implicit past, and other mysteries of the individual mind.
My friend’s lonely, tragic, and avoidable death was further egregiously mistreated by mainstream media as the final toll of a maligned and despised drug addict. The media almost certainly mistook a deliberate for an accidental overdose in the hands of an anesthesiologist and furthered injury by desecrating her memory. They did not highlight her years of excellent patient care, her dedication to an arduous and often thankless craft. I know better than to reduce the sum total of her to that reporting, because I knew some of her struggles. Looking back with the insights of a psychotherapist and colleague, I can see her loneliness and insecurities, and the perpetration of her work environment. It was the perfect storm from which she might have walked out whole if she hadn’t felt so all alone.
Maire Daugharty is an anesthesiologist who expanded her expertise by earning a master’s degree in clinical mental health counseling, merging her long-standing interest in mental health with her medical background. As a licensed professional counselor, licensed addiction counselor, and licensed marriage and family therapist, she brings a well-rounded perspective to her private practice, where she works with adult individuals and couples on a wide range of concerns. In addition to her counseling practice, she continues to work part-time as an anesthesiologist and has a deep understanding of the unique challenges faced by clinicians in today’s medical landscape. To learn more about her practice, visit Physician Vitality Services.
