Maybe you’re doing all the things.

You meditate, eat well, exercise, seek out appropriate social support, set good boundaries, and follow good sleep hygiene practices.

But you’re still feeling significant distress.

There can be a tendency to push ourselves harder, to berate ourselves for not feeling better despite our best efforts.

But this is often counterproductive.

You wouldn’t suggest chemotherapy for a broken leg.

Similarly, there’s nothing wrong or bad about adaptive self-care practices. But if you’re trying to address a problem for which self-care is not the solution, you won’t get the results you want. 

There are other options to manage your distress. Today we’ll talk about two of them, coaching and psychotherapy.

Physician coaching is becoming more widely available and accessible. Coaches frequently specialize in working with particular populations (e.g., early career physicians, introverted physicians, physicians who are mothers, etc.) and problems (e.g., burnout, desire for career change). Certification programs are available, but are not required for work as a coach (my own recommendation would be to seek someone who is certified and who specializes in what you need).

Coaching tends to be focused on helping you achieve future goals, though this process may involve an examination of past and present experiences and interactions to inform work towards those goals. Generally speaking, coaching is about growth. The growth may reduce distress, but coaching is not designed to address a disorder.

Insurance will not cover the costs of coaching because it is not intended to treat an illness.

On the other hand, insurance will generally cover psychotherapy because it is geared towards treating mental disorders. Some of the more common presenting diagnoses in the medical profession are related to depression, anxiety, trauma and stressor related disorders, or substance misuse.

Humans do experience trauma reactions in reaction to trauma.

The tautology is deliberate; I really want to underscore this.

The reactions vary from individual to individual and situation to situation, with different emotions, intensities, and durations. Sometimes substance misuse serves to soften the edges of our trauma exposure, though it is associated with problems of its own.

Though these reactions are expected, they are far from being accepted.

We can look specifically at trauma reactions in healthcare workers; many of you are exposed routinely to death, severe illness, and human suffering.

Burnout is a serious issue and there are a number of systemic changes that are needed to improve healthcare for its practitioners.

But burnout is not the same as a trauma reaction or major depression. Despite some comorbidity, it is a stretch to think that managing burnout can successfully address a clinical disorder.

Psychotherapists are specifically trained and licensed to treat mental disorders. There are a wide variety of therapy approaches and modalities that have a strong theoretical foundation and robust empirical support. 

As Marsha Linehan says about DBT skills, “every skill works for someone and no skill works for everyone.”

Along the same lines, empirically-supported treatments are just that, empirically-supported but by no means universal. You can look for a therapist who offers therapies that are consistent with your goals and desired approach.

If you are only seeking changes that are outside your personal control, therapy is not the best path to your goal. If, however, you would like to take control of how you respond to your situation and how it affects you, therapy is likely to be beneficial. 

Healthcare is not going to get easy. But if you can manage your distress, address your trauma, and reconnect with your purpose, it will get easier.

Resources:

• Physician Support Line (1-888-409-0141) is a free and confidential support line run by volunteer psychiatrists. It is open Mon-Fri (except federal holidays) 8:00 AM-12:00 AM EST. In addition to working with physicians, it also serves medical students.

https://www.physiciansupportline.com

• Physicians Anonymous is a resource for physicians, residents, and medical students. It also offers 1:1 coaching and free anonymous support groups. Finally, Physicians Anonymous maintains a blog that includes firsthand stories intended to reduce shame and stigma.

https://physiciansanonymous.org

• The National Alliance on Mental Illness (NAMI) has published a guide for healthcare professionals. The guide includes strategies for building resilience, promoting wellness, and accessing support.

https://www.nami.org/Your-Journey/Frontline-Professionals/Health-Care-Professionals