Breaking the Stigma — A Physician’s Perspective on Self-Care and Recovery

Adam B. Hill, M.D.

N Engl J Med 2017; 376:1103-1105

March 23, 2017 DOI: 10.1056/NEJMp1615974

http://www.nejm.org/doi/full/10.1056/NEJMp1615974

My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic. Several years ago, I found myself sitting in a state park 45 minutes from my home, on a beautiful fall night under a canopy of ash trees, with a plan to never come home. For several months, I had been feeling abused, overworked, neglected, and under-appreciated. I felt I had lost my identity. I had slipped into a deep depression and relied on going home at night and having a handful of drinks just to fall asleep. Yet mine is a story of recovery: I am a survivor of an ongoing national epidemic of neglect of physicians’ mental health.

AUDIO INTERVIEW

Interview with Dr. Stuart Slavin on depression and suicide among physicians and trainees and how to address stigma associated with mental illness.

Interview with Dr. Stuart Slavin on depression and suicide among physicians and trainees and how to address stigma associated with mental illness. (6:24)

In the past year, two of my colleagues have died from suicide after struggling with mental health conditions. On my own recovery journey, I have often felt branded, tarnished, and broken in a system that still embroiders a scarlet letter on the chest of anyone with a mental health condition. A system of hoops and barriers detours suffering people away from the help they desperately need — costing some of them their lives.

Last year, I decided I could no longer sit by and watch friends and colleagues suffer in silence. I wanted to let my suffering colleagues know they are not alone. I delivered a grand-rounds lecture to 200 people at my hospital, telling my own story of addiction, depression, and recovery. The audience was quiet, respectful, and compassionate and gave me a standing ovation. Afterward, hundreds of e-mails poured in from people sharing their own stories, struggles, and triumphs. A floodgate of human connection opened up. I had been living in fear, ashamed of my own mental health history. When I embraced my own vulnerability, I found that many others also want to be heard — enough of us to start a cultural revolution.

My years of recovery taught me several important lessons. The first is about self-care and creating a plan to enable us to cope with our rigorous and stressful work. Personally, I use counseling, meditation and mindfulness activities, exercise, deep breathing, support groups, and hot showers. I’ve worked hard to develop self-awareness — to know and acknowledge my own emotions and triggers — and I’ve set my own boundaries in both medicine and my personal life. I rearranged the hierarchy of my needs to reflect the fact that I’m a human being, a husband, a father, and then a physician. I learned that I must take care of myself before I can care for anyone else.

The second lesson is about stereotyping. Alcoholics are stereotyped as deadbeats or bums, but being humbled in your own life changes the way you treat other people. An alcoholic isn’t a bum under a bridge or an abusive spouse: I am the face of alcoholism. I have been in recovery meetings with people of every color, race, and creed, from homeless people to executives. Mental health and substance-abuse conditions have no prejudice, and recovery shouldn’t either. When you live with such a condition, you’re made to feel afraid, ashamed, different, and guilty. Those feelings remove us further from human connection and empathy. I’ve learned to be intolerant of stereotypes, to recognize that every person has a unique story. When we are privileged as professionals to hear another person’s story, we shouldn’t take it for granted.

The third lesson is about stigma. It’s ironic that mental health conditions are so stigmatized in the medical profession, given that physicians long fought to categorize them as medical diagnoses. Why do medical institutions tolerate the fact that more than half their personnel have signs or symptoms of burnout? When mental health conditions come too close to us, we tend to look away — or to look with pity, exclusion, or shame.

We may brand physicians who’ve had mental health conditions, while fostering environments that impede their ability to become and remain well. When, recently, I moved to a new state and disclosed my history of mental health treatment, the licensing board asked me to write a public letter discussing my treatment — an archaic practice of public shaming. Indeed, we are to be ashamed not only of the condition, but of seeking treatment for it, which our culture views as a sign of weakness. This attitude is pervasive and detrimental — it is killing our friends and colleagues. I’ve never heard a colleague say, “Dr. X wasn’t tough enough to fight off her cancer,” yet recently when a medical student died from suicide, I overheard someone say, “We were all worried she wasn’t strong enough to be a doctor.” We are all responsible for this shaming, and it’s up to us to stop it.

The fourth lesson is about vulnerability. Seeing other people’s Facebook-perfect lives, we react by hiding away our truest selves. We forget that setbacks can breed creativity, innovation, discovery, and resilience and that vulnerability opens us up to personal growth. Being honest with myself about my own vulnerability has helped me develop self-compassion and understanding. And revealing my vulnerability to trusted colleagues, friends, and family members has unlocked their compassion, understanding, and human connection.

Many physicians fear that showing vulnerability will lead to professional repercussions, judgment, or reduced opportunities. My experience has been that the benefits of living authentically far outweigh the risks. When I introduced myself in an interview for a promotion by saying, “My name is Adam, I’m a recovering alcoholic with a history of depression, and let me tell you why that makes me an exceptional candidate,” I got the job. My openly discussing recovery also revealed the true identity of others. I quickly discovered the supportive people in my life. I can now seek work opportunities only in environments that support my personal and professional growth.

The fifth lesson is about professionalism and patient safety. We work in a profession in which lives are at risk, and patient safety is critically important. But if we assume that the incidence of mental health conditions, substance abuse, and suicidal ideation among physicians is similar to (or actually higher than) that in the general population, there are, nevertheless, many of us out there working successfully. The professionals who pose a risk to patient safety are those with active, untreated medical conditions who don’t seek help out of fear and shame. Physicians who are successfully engaged in a treatment program are actually the safest, thanks to their own self-care plans and support and accountability programs.

Instead of stigmatizing physicians who have sought treatment, we need to break down the barriers we’ve erected between our colleagues who are standing on the edge of the cliff and treatment and recovery. Empathy, unity, and understanding can help us shift the cultural framework toward acceptance and support. Mentally healthy physicians are safe, productive, effective physicians.

The last lesson is about building a support network. My network has been the bedrock of my recovery. You can start small and gradually add trusted people, from your spouse and family to friends, counselors, support groups, and eventually colleagues. Then when you fall flat on your face, there will be someone to pick you up, dust you off, and say, “Get back out there and try it again.” A support network can also hold you accountable, ensuring that you remain true to your own personal and professional standards.

Without question, my own successful recovery journey has made me a better physician. My newfound perspective, passion, and perseverance have opened up levels of compassion and empathy that were not previously possible. I still wear a scarlet A on my chest, but it doesn’t stand for “alcoholic,” “addict,” or “ashamed” — it stands for Adam. I wear it proudly and unapologetically.

When a colleague dies from suicide, we become angry, we mourn, we search for understanding and try to process the death . . . and then we go on doing things the same way we always have, somehow expecting different results — one definition of insanity. It’s way past time for a change.

Disclosure forms provided by the author are available at NEJM.org.

SOURCE INFORMATION

From the Indiana University School of Medicine and the Riley Hospital for Children, Indianapolis.

Nontraditional Careers in Nursing: Options for Nurses

History of Nontraditional Careers

Source: Nontraditional Careers in Nursing: Options for Nurses

Susan E. Lowey, PhD, RN, CHPN

|March 15, 2017

The Nursing Workforce and Changing Demographics

While a majority of nurses currently work in the hospital setting, the nontraditional (nonhospital) nursing sector is growing.[1]

There are currently over 2.7 million registered nurses in the United States.[1] This figure is expected to increase 16% by the year 2024, with nursing employment surpassing the growth of most other health-related occupations.[2] The upcoming expected growth of the aging population, particularly the baby-boomer generation, will require a larger nursing workforce to provide and coordinate care. The increased prevalence of chronic conditions, such as heart disease and diabetes, will also precipitate the need for a larger nursing workforce.[3]

Patients are living longer but often with multiple chronic conditions and functional impairments. While there will always be a need to have a robust nursing workforce within the inpatient hospital setting, future projections show an increased growth of nursing jobs in nonhospital community-based healthcare settings.[4] More patients will require comprehensive outpatient nursing care to manage both acute and chronic conditions.

The function of nurses is to promote wellness through prevention, to restore health and functioning to those affected by illness or injury, and to advocate for the care of individuals, families, and communities.[5] The changing dynamic of the nursing workforce will extend these activities to a wide variety of nonhospital settings.

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Faculty Training Modules: Working with students with disabilities

UCSF Medical Student Disability Services (MSDS) and UCSF Student Disability Services (SDS) in partnership with colleagues from around the country (Case Western Reserve University, Duke University, Northwestern University, Rush University College of Medicine, Stanford University School of Medicine, The University of Washington, and Weill Cornell Medicine and Samuel Merritt University), developed The UCSF Faculty Training Series, an eight part online, video training series to guide faculty who work with students with disabilities. New modules will be posted each month.

The new modules include:
Keeping it Confidential: Guidance for working with students with disabilities
 
                                                           and


Accessible Admissions Practices: Making sure students with disabilities are addressed

Four additional modules are planned for this series including: 
  1. Microaggressions: What they are and how they impact students with disabilities
  2. ADA 101: The basic laws that govern disability services
  3. Accommodations in the Clinical Setting
  4. Full Circle in the Diversity initiative: Inviting Disability to the table

 

Disability Stigma and Your Patients | Rehabilitation Research and Training Center on Aging With Physical Disabilities

Source: Disability Stigma and Your Patients | Rehabilitation Research and Training Center on Aging With Physical Disabilities

For people with disabilities, stigma can be a major barrier to participation. Stigmatizing attitudes about disabilities can also affect relationships between patients and providers. However, health care providers can be allies with their patients and help reduce the impact of stigma.

Conference | DDNA

Source: Conference | DDNA

“Celebrating our Past, Shaping our Future”

2017 Conference Overview

The 2017 conference theme is “Celebrating our Past, Shaping our Future!”  As the premiere resource for practicing I/DD nurses, DDNA is committed to providing quality education programs that include cutting edge content with practical application.

CONFERENCE PROGRAM STRUCTURE It’s all about the CEs!

DDNA’s 2017 annual conference will be structured a bit differently than in previous years – offering a longer conference program and more accredited continuing education courses and opportunities! The conference registration fee will include 3 ½ full days of conference program and continuing education, offering over 23 hours of continuing education.

As we celebrate our silver anniversary, we would also like to offer our members an additional reason to celebrate with us!   With the longer conference program and additional continuing education, this year’s conference rate is 5% below the 2016 conference fees for comparable hours of continuing education.  The conference will also offer a pre-conference program, providing 6 additional hours of continuing education, available to all conference attendees as an additional purchase!

The result – over 29 hours of continuing education are available with attendance at all conference and pre-conference programs!

Target audience: Health care professionals working in the field of intellectual and developmental disabilities.

Overall objectives: The goals and objectives of the conference are:

  • To present cutting-edge education on the most up-to-date practice issues and research regarding the specialty of developmental disabilities nursing.
  • To provide a forum for networking and to facilitate the sharing of information to improve nursing practice in the developmental disabilities field.
  • To bring together leaders and experts in developmental disabilities to engender consensus that improves the health and lives of persons with developmental disabilities.

Partnering to Transform Healthcare with People with Disabllities (PATH-PWD) – Improving Acute, Primary and Transitional Health care with People with Disabilities | | Rush University

Research Team Sarah H. Ailey Principal Investigator Rush CON Molly Bathje Co-Investigator Rush CHS Tamar Heller Co-Investigator University of Illinois Award Period 6/1/16 – 5/31/17 Funding Source Agency for Healthcare Research and Quality (AHRQ) R13 Conference grant

Source: Partnering to Transform Healthcare with People with Disabllities (PATH-PWD) – Improving Acute, Primary and Transitional Health care with People with Disabilities | | Rush University