Can anxiety be severe enough to cause a physician to leave medicine? Absolutely. I know a number of physicians who have left for this reason. In my coaching practice I am increasingly aware of the toll anxiety takes on many doctors and am making it my mission to bring more attention to this problem and to find solutions. The physicians I have talked to are just the tip of the iceberg in terms of those “suffering in silence” from anxiety.
For this blog, I interviewed one of my clients who agreed to discuss her difficulties with anxiety. Identifying details, including her name, have been changed to protect her privacy.
Background: “Dr. Susan” had done very well in her training and had practiced a number of years as a well-respected surgeon when she developed a problem with anxiety. When she first contacted me she had stopped working because of the anxiety and was inquiring about non-clinical options.
Q: When did anxiety become a problem for you as a surgeon?
Dr. Susan: After about 10 years in practice, I had a panic attack and I worried that this would happen again. It probably wasn’t a true panic attack, but I was doing a long surgical case and I had a fever and I was afraid I would pass out. I got dizzy and had to step away and this was truly a first for me. My partner finished the case for me. The next time I was doing a surgery and the patient was awake, which made it worse, and I got dizzy again. I didn’t sit down but somehow managed to get through the procedure. After that I was really anxious about it happening again. I started to worry about what I would do if it happened again, what would I say if the patient was awake. The fear permeated everything. I would worry about it at home. I would think I didn’t want to go to work for fear of it happening again. I began imagining all sorts of different things that could go wrong.
After this I was plagued by the “What if’s?”
“What if I have Ménière’s disease or Multiple Sclerosis?”
“What if this happens again?”
“What if my hand jerks and the patient notices?”
“What if I am not able to do my job as well as I should?”
Q: Did you talk to anyone about your anxiety or seek help?
Dr. Susan: I talked to my husband, but I didn’t want to consult a psychiatrist. There were several reasons. I thought it would go away or I would be able to handle it. Sum it up to pride. I felt like I should figure it out. I didn’t have time. I didn’t know if anyone could help. I also worried that seeking help might present a stigma against me, or that they would just want to put me on medication, and I didn’t want to do that. I didn’t want this to be in my (medical) history.
Q: How did you try and cope with your situation on your own?
Dr. Susan: Every day I would have to talk myself through work – “It will be fine, nothing bad will happen, you’re fine, you’ll get through the day.” I’d have these conversations with myself. I tried to exercise in the morning, but it didn’t help. I went to a Vitamin Cottage and looked at some herbal remedies like Valerian. I thought about St. John’s Wort, but I was afraid these might have some bad side effect and I didn’t take them.
Q: What was the state you were in when you contacted me for coaching?
Dr. Susan: I had stopped working and had decided I was not going to work clinically anymore. I was happy as I didn’t have the stress anymore, but I didn’t want to leave on a down point. Really, I didn’t feel very good about this. I wanted to be able to work this out. If I was going to leave medicine, I wanted to do it on my terms, not because the anxiety was forcing me to quit.
Q: When you quit work, did anyone know your reasons for leaving?
Dr. Susan: Only my husband. No one knew what was really going on. It was an internal battle.
Q: How was the anxiety affecting your home life?
Dr. Susan: Even at home I was preoccupied with anxiety – at least 50% of the time. It was hard for me to be present with the kids. We’d be doing fun activities but it was hard for me to enjoy myself.
Q: How was your stress level during residency?
Dr. Susan: I liked learning new things and the challenges of complicated surgeries. The stress felt normal; it was a part of learning and I thrived on it. But once I learned to do my cases, it seemed like I was adding to my own stress with the worry – like I needed a certain amount of adrenalin.
Q: Had you considered a nonclinical career as a way out?
Dr. Susan: I did consider some other type of work, but I would only be briefly interested in it. I didn’t see anything where it would be much more than getting paycheck.
Q: How were you able to turn your anxiety around and start working again?
Dr. Susan: I took some time off. This helped me to have a break and figure out what is important to me. I was lucky to be able to take a break. You talked to me. It was really helpful to know that I was not the only person dealing with this kind of thing; that I was not abnormal and I was not alone. That took a big weight off. It was also helpful to know about my personality type and that this type tends to have more trouble with anxiety. I read a lot on the power of positive thinking and books dealing with anxiety. It helped me to see that there were all these books dealing with anxiety – I realized there must be a lot of people who have this problem.
Q: You were able to make a change in your situation rather quickly. What else did you do to lessen the anxiety?
Dr. Susan: I also went through in my head several questions— “Are you going to try your best? Of course. Is your best good enough? Of course. Even when you felt anxious on the inside, did the surgery still go well or were there any problems? Everything was fine.” Then I would usually tell myself to quit making a big deal out of nothing and move on and learned to ignore it. I would repeat the saying, ‘”Keep Calm and Carry On,” a lot. I am still working on the ignoring part but it is better not to dwell on it and just simply think of something else.
I would tell myself that all I can do is do my best and I had to get over expecting myself to perfect and know that if something came up I would figure out how to handle it. I needed to give myself some credit for the person who got through all that training and know there’s a reason you go through all the training. It becomes part of who you are and it is OK to rely on it.
Q: How are things for you now that you are working as a surgeon again?
Dr. Susan: I am doing less elective and more urgent or emergent surgery, the patients are more acutely sick and have more medical problems in general. I feel much better. When I am driving to work I am always a bit nervous, but when I leave I am feeling – “Oh that was rewarding.” I can actually do this and enjoy it. I tell myself I am going to try my best and my best has always been good enough. Every time I get a little better. I sleep at night. Before I wouldn’t sleep well at all.
Q: On a scale of 0 -10 what level was the anxiety level at before and what is it now?
Dr. Susan: Before the anxiety was an 8/10. Now it is a 3/10.
Q: What advice would you give to other doctors who are struggling with anxiety?
Dr. Susan: I would tell them that this is a common problem and not to let it get to the point where it becomes a run-away train. Some amount of nervousness is normal. Give up some of your control and perfectionism. Every day is different; you can’t control everything and be perfect all the time. You can only do your best and let that be good enough.
Please feel free to comment on this interview as I will be posting replies from “Dr. Susan.” In an upcoming blog I will be offering some different resources for dealing with anxiety.