Latest news with #KathyMayTran
Medscape
a day ago
- Health
- Medscape
Sick Doctors: Don't Be the Kind of Patient You Hate
That night changed her. 'You always think, oh, that's never going to happen to me,' Sullivan says. 'I'm young, I'm healthy, I work out every day, I'm vegan. But that feeling of I could die tonight, especially as a doctor, it changes your perspective on everything.' The White Coat Comes Off Doctors spend their careers taking care of patients. But when the roles reverse, it's often disorienting. Many physicians report difficulty trusting the system they helped build — they second-guess diagnoses, resist rest, micromanage their own care. Kathy May Tran, MD 'They are often not used to taking care of themselves or being taken care of,' says Kathy May Tran, MD, a physician at Massachusetts General Hospital, Boston, and advocate for clinician well-being. 'A challenge arises when the physician becomes a patient. Then, the repeated dosages of pain, fear, anxiety, or grief arise from the physician, not the patient, and the physician cannot adaptively separate the physician emotions from the patient emotions.' The stakes are high. Nearly half of all US doctors — 45.2% — reported symptoms of burnout, according to a 2025 study in Mayo Clinic Proceedings. That number is down from a pandemic-era peak, but still far exceeds the burnout rates of other American workers. Doximity's 2024 Physician Compensation Report found that 8 in 10 physicians say they're overworked. Mental health issues, chronic fatigue, and age-related conditions are on the rise in medicine. But the culture still whispers: Doctors don't get sick. Or if they do, they don't talk about it. Interns who screen positive for depression seek help just 22% of the time. Many doctors fear that admitting illness could jeopardize their license, their practice, or their reputation. What happens when the stethoscope comes off and the wristband goes on? The Double-Edged Sword of Medical Knowledge A physician's clinical expertise might help her recognize early symptoms or communicate more effectively with care teams. But it can also fuel anxiety, second-guessing, and a paralyzing awareness of what could go wrong. David V. Diamond, MD 'I ran a healthcare system,' says David V. Diamond, MD, aged 73 years, former chief of medicine at the Massachusetts Institute of Technology, Cambridge, Massachusetts, who was diagnosed with myelodysplastic syndrome in 2018. 'I practiced medicine for over 40 years. I knew all the vagaries of how systems can be as weak as the weakest link, you know? There's always someone who messes up or forgets something or does something wrong.' After being given just a 6% chance of survival, he approached his 2019 bone marrow transplant with trepidation — not just because of the procedure but also because he knew how human error could tip the scales. Sullivan knows that unease. For her, the deeper issue was psychological. 'As a doctor, you're supposed to be the strong one,' she says. 'You're supposed to guide the others through this. I will freely admit it, I don't want to be seen as weak.' Like many physicians, Sullivan found it difficult to trust others with her care, even doctors she respected. 'Half the reason I became a doctor and half the reason my husband became a doctor was to protect our families from bad doctors,' she says. 'Relinquishing control to somebody else is really hard, even if you know that they're fully capable.' The culture of clinical stoicism — the expectation that doctors keep it together no matter what — leaves little room for uncertainty, fear, or weakness. Peter Grinspoon, MD 'There are societal expectations that we're supposed to be these robots that just show up to work and perform without any problems,' says Peter Grinspoon, MD, aged 59 years, a primary care physician at Massachusetts General Hospital and an instructor at Harvard Medical School, Boston. 'When in reality, not only do we have the same problems that everybody else has — like elderly parents, bipolar [disorder] issues, divorces, kids that are troublesome — but we also have the unique problems of being a doctor.' Grinspoon speaks from hard-won experience. At age 33, addiction overtook his life. He snorted oxycodone in his office, forged prescriptions in the names of family members, and struck secret deals with patients to share narcotics. 'In my head, it was no different than people who have a drink after work,' he says. 'I also justified it as, like, I'm a primary care doctor. I'm giving every molecule of myself at this crappy, underrated job to help other people, which is so draining. The least I deserve is to rest and relax after work. It could be excruciating being a primary care doctor.' He felt justified: 'I work so hard to help other people, so therefore, I deserve to do this thing that I've discovered to get rid of all my stress,' he says. 'It was not a good conclusion.' Letting Go Without Falling Apart 'Many times, physicians don't take instructions well,' says Bala Subramaniam, MD, professor of anesthesiology at Harvard Medical School. 'We think we know it all.' Subramaniam suffered a heart attack in 2021. But he was prepared in an unusual way. For nearly a decade, he'd dedicated 2-3 hours a day to yoga and meditation, cultivating what he calls 'stillness and enhanced awareness.' When the heart attack came, it didn't bring panic or fear. 'I was surprised that there was zero fear. The chest pain came with no suffering, just pure awareness,' he says. His mind remained calm as he told his doctor, 'I feel my lungs are flooding. Could you please give me some Lasix?' His presence of mind didn't come from trying to control the doctors around him but from mastering what was happening inside himself. That distinction — between controlling others and participating in your own care — is what made the difference for Diamond. His experience, he says, was overwhelmingly positive, and not because he called the shots. 'It just reinforced my personal philosophy and approach to medicine,' he says. 'Because I had really good doctors who practice medicine the way I practice medicine, which is they listen.' Diamond embraced a collaborative role. 'If there was a choice to be made and it wasn't really clear which way to go, we would engage in a little discussion and they would try to get my opinion, and sometimes I made the decision. Sometimes I was like, 'I'm not sure, you decide,' in which case they decided.' He didn't need to dominate the process. He just needed to be part of it. 'I was happy for the treating physicians to make the big choices because I figured they knew best, right? And I didn't become the world's expert on my disease or its treatment. I mean, I knew what was going on, but it's not like I was researching things and saying, 'Did you read the article in Science that says this is better or that's better?' I didn't do that. I was happy to be supported by the system.' Now retired, Diamond thinks his experience would've helped him if he'd returned to the clinic. 'I think I would've been perceived a little differently, certainly by people facing cancer,' he says. 'Maybe my story and my survival would in some ways have been more encouraging.' That kind of personal experience, says Tran, can be meaningful. 'Understanding the patient's experience as fully as we can, with compassion, empathy, and connectedness, is fundamental to be an effective physician who practices patient-centered and individualized medicine.' When Control Isn't Comforting When Sullivan landed in the hospital with AFib, she had to confront something new: helplessness. 'When you're in AFib, you can feel it,' she says. 'I'm not somebody who likes to really ever admit that there's something wrong.' Her husband told her what any well-meaning spouse might. 'Mish, I'll let you know if it changes. Just try to sleep, try to rest.' She tried, but it didn't sit right. Then, in the middle of the night, something shifted. 'They had planned for a cardioversion the next morning,' she says. 'I woke up and I looked at Bill and I said, 'I'm in sinus.' And he goes, 'How do you know?' I just knew. The palpitations were gone. I beat the cardioversion.' Her echo looked great, and the diagnosis never fully clarified her heart issue. 'It was a one and done.' If that was a moment of grace, Grinspoon's wake-up call came with handcuffs. In 2005, the state police and drug enforcement administration (DEA) showed up at his Boston office. He was charged with three felony counts of illegally prescribing a controlled substance and sentenced to 90 days in rehab. 'I'm an atheist Jew from the Northeast who got forced by the medical board to go to this very Christian rehab in Virginia,' Grinspoon says, calling it 'not the most scientifically based experience of my life.' He couldn't believe the rigidity. 'You literally just have to do what you're told. You just have to surrender. There's no advocacy as a physician who's in trouble.' The result was three and a half years without a medical license. Now, his license has been back for 15 years, and he's been in recovery for 20 years. Looking back, Grinspoon sees a system designed more for punishment than healing. 'If we were just more supportive and less punitive, we could help people earlier along in their addiction, so it doesn't only become a problem when a surgeon shows up drunk in the OR or a primary care doctor gets raided by the DEA.' He now attends physician-specific support groups. 'We talk about our frustrations and how you have to sort of let go and ask for help, and how being the doctor in charge of everything is part of how we got into this problem in the first place.' Learning to Let Go, on Your Own Terms For doctors who become patients, healing often starts with autonomy. Grinspoon urges physicians to seek help quietly and deliberately. 'It's about getting treated on your terms,' he says. 'So go to a private addiction specialist and do what you have to do to clean up.' If you become a patient, Sullivan advocates researching doctors. 'There are enough docs out there who I wouldn't want touching my family.' Control, she's learned, is not something to abandon lightly, it just has to be redefined. Subramaniam, the Harvard anesthesiologist, believes the medical community needs to evolve altogether. 'We truly don't understand the psychological component of all illnesses,' he says. 'We may intellectually understand that psychological component, but we don't truly know it.' He's not talking about patient care alone. He's talking about doctors, too — how they break, how they heal, and what keeps them going. For Diamond, writing became his lifeline. During his cancer treatment, he began updating a private CaringBridge blog. 'At first it was matter-of-fact reporting,' he says. 'But then I started slipping into metaphor and prose and soft reflections. People appreciated my honesty and my writing.…That gave me strength.' He believes others could benefit from the same. 'Writing down their thoughts and feelings is a good way not only to hear themselves but to share what they're going through in a way they couldn't really in conversation.' Tran, who launched a storytelling series at Massachusetts General Hospital, says 'The process of recollecting and retelling is extremely therapeutic for the storyteller and for those who hear it. They discover truths about themselves and their lives.' In fact, she adds, 'The most impactful and effective way to become a better physician is to become a more grounded human….Embracing our 'human' side is what makes us better physicians.' Even now, Sullivan says she's still working on it. 'I get a lot of inspiration from my husband. He's an ER doc and also an attorney, so he's a pretty bright guy.' But when he was diagnosed recently with thyroid cancer, something surprised her. 'For how in control he is for most of his life, he readily allows others to step in when he becomes the patient, and he trusts them — including me — which is something, right?' She pauses, thinks about that for a moment. 'I really want to get there.' Are you a doctor with a dramatic story about life as a patient? Medscape would love to consider your story for Dr. Patient. Please email your contact information and a short summary to access@ . Read more in the series: A Doctor's Tumor Rupture Upends All She Thought She Knew Lead image: Medscape Composite: Dreamstime Image 1: Medscape Composite: Getty Images Image 2: Michael and Michelle Sullivan Image 4: David V. Diamond
Medscape
03-06-2025
- General
- Medscape
The Art of Sharing: Telling Stories With Your Patients
How much of yourself do you share with your patients and their parents? Your colleagues? Your partners? I'm not talking about time and energy. I'm asking about the stories you tell. I recently read an interview with the two physician authors who have just published a book titled Becoming a Better Physician . The subtitle of the book is 'Insightful and Inspirational Stories from Attending Physicians, Residents and Medical Students.' In the interview in Harvard Medicine, the authors, Mark Goldstein, MD, and Kathy May Tran, MD, say that 'openness was one of the primary goals when working on the book.' They observe that showing one's vulnerability is often interpreted as a sign of weakness, particularly among members of the medical profession. William Wilkoff, MD Prompted by the general increase in burnout, the authors are hoping that by sharing their stories and the stories of other health professionals, more physicians will feel comfortable telling their stories and benefiting from the catharsis that often follows the telling. Tran says she sees one of our roles as physicians as being storytellers. We elicit and listen to the stories of our patients, and then in turn take what we have learned about the patient using our knowledge and other diagnostic tools to construct a story which we then tell — but we are very reluctant to tell our own stories. I completely agree with the authors about the cathartic benefits of storytelling, and I hope their book will encourage more physicians to tell their stories at every stage of their professional trajectories. However, the barriers to sharing are real and in some cases self-imposed. I'm told that before my time, in many communities, physicians traditionally took Wednesday afternoons off and played golf. I'm not sure if this is true, but I suspect that there were more opportunities back then for physicians to rub elbows and swap stories than there are now in the fast-paced, time-limited world of 21st century medicine. Although there is currently a strong emphasis on care delivery by 'the team,' and some of it is out of necessity, the practice of primary care pediatrics is still a stream of one-on-one encounters between the patient and the physician. Ironically, in an environment populated with scores of assistants and care seekers, the physician can often feel lonely. Reading the stories of others who have walked the same walk can be enlightening and soothing, but it is really the process of sharing one's own story that can be the most therapeutic. Not everyone has the time, skill, or contacts that allow them to share their stories with a broader audience. Historically, keeping a diary provided a vehicle for expression; it can still have its benefits, but merely expressing yourself pales in comparison to the cathartic value of sharing your experience with a fellow traveler. I was fortunate to have found someone to share my stories with while I was in medical school. That good fortune continues to be a reminder to me that we should be putting more emphasis on the topic of relationship-building as we prepare students for the challenges they may face on the path to a rewarding career in medicine.
