Finding it difficult to sleep? Do your personal demons taunt you about your deepest fears? Are you haunted by mistakes you’ve made? It’s Halloween-time, but it’s not ghosts, goblins, and ghouls that frighten physicians. Outwardly, doctors often appear confident, even fearless. But, more than most workers, doctors can be inwardly troubled by fear—fear of doing the wrong things or fear of not doing the right things. These are the torments that trouble physicians’ souls. These are the fears that keep doctors awake at night… Fear of a malpractice lawsuit The most common claim for a medical malpractice lawsuit is failure to diagnose/delay in diagnosis. So, if you’re a doctor in fear of being sued, what do you do? You err on the side of caution and order additional tests or superfluous treatments. And that’s why physicians themselves say about 20% of all medical care is unnecessary, according to a survey conducted by Johns Hopkins and Harvard researchers. Indeed, about 85% of physicians surveyed in this study said fear of malpractice was their number one reason for over-testing and overtreatment. Fear of death Some doctors never see death face to face. Some see death occasionally. And some doctors see death every day. Surely, most doctors—the last group, at least—become unfazed by death at some point, right? Death becomes so commonplace that it no longer strikes fear in their hearts? Don’t believe it. In fact, doctors may fear mortality more than anyone else. Perhaps that’s why they get so close to it—because they want to defeat it, argues Sherwin B. Nuland, MD, in his book How We Die: Reflections of Life's Final Chapter. “[O]f all the professions, medicine is the one most likely to attract people with high personal anxieties about dying. We become doctors because our ability to cure gives us power over the death of which we are so afraid, and loss of that power poses such a significant threat that we must turn away from it,” Dr. Nuland wrote. Fear of inadequacy Patients put their trust—their very lives—in doctors’ hands. So, to assure patients of their competence, doctors must appear confident. Yet, behind that confident manner, many doctors are secretly insecure. Even the most accomplished ones have a fear of inadequacy—a fear of being “found out” that they’re not the success they may appear to be. This is called imposter syndrome, and many doctors suffer from it. Approximately 30% of family medicine residents and 44% of internal medicine residents say that they feel like imposters, according to researchers. But it’s not just residents and less experienced doctors; it’s pervasive throughout the profession. “I discovered that the big problem with imposter syndrome is that it prevented me from taking pride in my work. It preys on that third leg of burnout—a lack of efficacy or a sense that nothing that you do matters,” wrote emergency physician Arlene S. Chung, MD, MACM, in an article for KevinMD. “It’s a cousin to perfectionism. The more and the greater the accomplishments, the wider the disconnect between reality and perception, and the worse the feelings of shame, inadequacy, and guilt.” Fear of losing autonomy Not long ago, back in the 20th century, doctors had much more autonomy and respect. Physicians ran hospitals, group practices, and solo practices. Their autonomy, for the most part, allowed them to make decisions that were first and foremost in the patient’s best interest. But now, the landscape has greatly changed. Other people and entities are taking the decision-making out of doctors’ hands. “Most hospital executive suites are disproportionately filled with lawyers or businesspeople,” wrote cardiologist and author Sandeep Jauhar, MD, PhD, in an op-ed in The New York Times. “Indeed, the number of non-medically trained hospital administrators has gone up 30-fold in the past 30 years, while the number of physicians has remained relatively constant.” Of course, it’s not just administrators. Health insurance companies effectively dictate care by what they will and won’t pay for. In addition, patients are encouraged to advocate for their own care, but in doing so, many doctors are now vying with “Dr. Google” over what’s best for the patient. In addition, EHRs and artificial intelligence systems are now being trained to assist doctors in decision-making. How long will it be before administrators decide that electronic systems make better decisions (or at least more efficient or more cost-saving decisions) than doctors? Fear of failure Fear of failure is the greatest fear for most physicians—and with good reason. The stakes are high in medicine, sometimes a matter of life and death. Doctors feel they need to make the right call every time. There’s no room for mistakes. “As the pace and pressures of being a doctor increase each year, so do the fears of making a mistake. Doctors fret over errors all the time and worry their patients will be hurt by something they failed to do,” wrote healthcare thought leader Robert Pearl, MD, in an article for Forbes. In other words, Dr. Pearl argues that these mounting pressures on doctors are adding fuel to their inescapable fear of failure, thus increasing its power over doctors. “The result: growing reports of depression, burnout, and suicide among physicians,” he wrote. The sum of all fears What can you do about these fears? First, don’t pretend that they don’t exist or that you’re not feeling them. Ignoring them won’t help. Instead, recognize your fears. Identify them. “Diagnose” them. And then seek out treatment or therapy to help lessen their effects. If nothing else, talk to another doctor who will truly listen, and be willing to listen to their fears, as well. As Lucy, at her psychiatrist booth, said to Charlie Brown: “The mere fact that you realize you need help indicates that you are not too far gone.” So, don’t fear: You are not too far gone. Source
