Most, perhaps all of us, believe that we are ethical doctors and are, in some definitive way, different from those in our profession whose violations we may have heard or read about. Until recently, I was no exception. After all, I considered myself to be a good doctor and a good person, and was generally respected and well-liked by patients, colleagues, and staff. I had abundant confidence in my abilities; even as I remained surprisingly unaware of my vulnerabilities and unmet needs. I was dismissive of the entire subject of “physician health,” and did not consider myself to be at risk for any form of illness, or any vulnerability to personal boundary issues that could (and did) lead to professional misconduct. So it was a terrible shock to me to be confronted with my personal involvement with a patient, and to realize that somehow, I had indeed become someone I thought I had no possibility of becoming. “You will need to contact a lawyer right away,” I was told by the chief of medicine and the president of the medical staff, as they explained that my privileges would be suspended immediately and that I would be fired. The previous day they had received credible information that I had become involved with a patient, and I confirmed that what they had learned was true. Several months later the Board of Registration in Medicine permanently revoked my license to practice medicine in the state of Massachusetts, which I later learned effectively prevented me from obtaining a license anywhere. I would be allowed to re-apply for a license in five years, but unlike in cases of alcohol or drug addiction, there was no agreed-upon or recognized program for recovery in the state of Massachusetts, and it was clear that my chances of ever practicing again would be slim regardless of what I chose to do.
That was many years ago. After 15 years of practice, in a progressively more secretive, confused, and desperately needy state of mind, I made choices and engaged in behavior that directly harmed my patient and indirectly harmed just about everyone else in my professional and personal life. It was the low point of my life, what recovering addicts would refer to as “hitting bottom.” I had lost my job, my profession, my reputation, and my very sense of who I was and what I believed in. I had betrayed my patients, my colleagues, my profession, my wife and family, and myself. And because my wrongful behavior involved violation of professional boundaries, I was portrayed in the media as an evil person whose apparent decency was merely a cover for his darker purposes. My path toward recovery began at 4 a.m., just hours before the meeting described above, when I awoke my wife and informed her of what was to happen that day and the reasons for it. As painful as that was, it was the first step toward honesty and away from secrecy and lies.
Later that day, after again telling the truth in the meeting, I did contact a lawyer, and agreed to meet with him the next day. It was at that meeting that he told me about Physician Health Services (PHS) and the role the program could play in assisting me — not with my legal troubles or licensing challenges, but with me, which was what I needed the most. I called that same day, and had an intake meeting the following day. The director of PHS met with me and listened to my story. He did not treat me as a “bad” person who needed to be punished, but he identified and acknowledged my illness and vulnerabilities and encouraged me to get well. He guided me through the available treatment options and gave me thoughtful referral advice for a local individual therapist and an intensive treatment program. He also offered that upon completion of treatment, I could enter into a monitoring agreement with PHS. My five weeks in treatment were transformative. The staff at my treatment center was a small group of exceptional people whose expertise and generosity of spirit I will always treasure. Not only did they help me through the most painful and difficult months of my life, but they also provided the necessary assistance to my wife as an individual and to us as a couple to help us weather the crisis without losing our marriage. Our gratefulness for that is eternal.
There I met other professionals — mostly physicians — who had also engaged in behaviors that jeopardized their licenses to practice because of illnesses such as alcohol and drug dependency, depression or anxiety, and other mental health issues. Each of these professionals was instrumental in teaching me important lessons about my own vulnerability, human needs, unexamined motives, pride, and fear. My extensive evaluation revealed that I had critically limited psychological skills in the areas of self-awareness, assertiveness, limit setting, and independent problem solving. I was diagnosed with a mood disorder with anxious features and was started on a medication. Upon returning home, I began attending a PHS peer support group. Although it was composed almost entirely of alcohol and drug addicts, and utilized the structure and conventions of an AA meeting, I was able to completely identify with members of the group in fundamental ways. I, too, had “hit bottom,” experienced the “gift of desperation,” and needed to proceed one day at a time to restore myself to sanity, make the amends I could for the harm I had done, and rebuild my life in a healthy way. This group was actually sitting around a table talking about their inner experiences in as honest and heartfelt a manner as possible. This in itself was a minor miracle, and a process in which I long needed to take part.
My monthly meetings for more than four years with my PHS associate director were like the mile markers along the highway. She helped me trace my progress and see where I was, how far I had come, and where the road ahead might take me. She has been an unfailing advocate and has always understood that although I began a monitoring program for psychiatric reasons, in larger measure it was for the entire me — my composition, my way of thinking, my behaviors, my actions, and my choices. I was very lucky, or else PHS was particularly wise, in finding a psychiatrist with whom I could work through the issues and the actions that brought me the attention of my hospital, the licensing board, and the public at large. These matters were extraordinarily difficult to confront, but my psychiatrist was able to help me accept who I was and what I had done, while at the same time keeping the focus on growth and change. He also prescribed my medication and validated my impression of the changes I attributed to its effects. The improvement in my mood and reduction of my anxiety allowed me to get acquainted with a whole new way of being in the world. Previously, I felt compelled to help others; to make them feel good — so I could feel good myself. What looked like, and was in part, kindness, generosity, and the exercise of my talents, was, at another level, a compulsive effort on my part to meet my own unrecognized needs.
I learned much more about this and met many more fellow sufferers through my involvement with an organization specifically aimed at addressing professional boundaries. I also joined a local writing group that met weekly at the community center. Regular writing of my own and exploration of others’ writing was yet another way of improving my ability to identify and describe my feelings and share them in a creative way. It also awakened within me an appreciation of my skillfulness with words, and facilitated my transition to a new career as a medical writer and creator of continuing medical education materials. Today I am employed full time as a scientific director at a medical education and communication company. Over the past five years I have enjoyed a much closer relationship with my children. As the primary caretaker and homemaker, I was in a position to be much more involved in their lives than most mid-career fathers. My wife and I have emerged from this catastrophe with a strong marriage, and currently enjoy our new, shared hobby: ballroom dancing.
There is, of course, so much more to the story. My sincere hope, however, is that any physician who is suffering now will feel encouraged by what I have written to seek assistance before a major crisis requires it. There is no better place to start than PHS.
How to make a referral to PHS
