COACHING FOR PHYSICIANS
THERAPY FOR PHYSICIANS
Seen as the pillars of communities, physicians may find that they have no one they can turn to when times are rough. For our physicians, our life-givers, these three statistics are especially dumbfounding as they are disturbing: 29 percent of resident physicians experienced depression; 16 percent of emergency physicians met the criteria for a post-traumatic stress disorder diagnosis, and doctors have a higher risk of death by suicide compared to many other professions. We stand to lose one doctor a day to suicide!
And these are just the facts pre-pandemic. The pandemic worsened the stress on health professionals and created more fractures for failing health systems. Doctors are experiencing burnout from new challenges they encounter, feeling drained by society's tendency of installing them as heroes, moral injury when they are caught between their Hippocrates oath and corporate practices that may require them to transgress on their values, fatigue from managing their reputations, relationships, and practice (scroll below to read some of their stories with identifying details changed). Doctors can tolerate high levels of stress for protracted periods before they will buckle - but it doesn't that they should tolerate exceptional stress or that when they do, it won't leave its marks on them! Prolonged stress can skew normal responses causing snap decisions or paralyzing skepticism during decision-making. Coping behaviors mistakenly perceived by physicians to be driving their success, such as compartmentalization, can also affect their psyche, heath, and relationships.
We are learning today that burnout is not simpy a rite of passage. Stress can impact one's connection with oneself and others. All such seemingly innocuous endeavors- the ability to sleep soundly at night, lose weight, eat healthy, maintain close relationships, erect healthy boundaries, and engage in one's interests are connected with keeping stress levels down. Amidst greater awareness of mental health we are seeing more physicians invested in seeking #mentalhealth.
Whether you've been home-schooling yourself on what it means to self-care, or have been to a therapist (or several) previously and feel disheartened, or have never encountered a therapist before, all is not lost. Dr. Sandhya, the coach, has had success with all kinds of clients who have experienced dejection and lack of results with therapy, previously. She specializes in discreet, focused, high-caliber care with concrete self-care strategies for medical providers at different stages of their careers for a variety of concerns.
Curated Coaching Sessions for Protecting your Mental Health
Our coaching sessions are designed to promote the wellness and mental health of busy physicians, and others desiring a caring and personalized environment to repair or grow. Sessions are of a short-term duration, yet meaningful, purposeful, and impactful to assist you in meeting your specific goals. For those who prefer the convenience of virtual visits we are able to offer Zoom/ telehealth appointments. In our uniquely tailored 12 coaching sessions, you can gain practical tools for healthy coping for any psychological first-aid and/or a more intentional exploration of psychological triggers from your professional and personal lives that can interfere with your drive, self-worth, and success.
Dr. Sandhya has provided short-term and long-term coaching for students, medical residents, and physicians all over the US, and in particular, at The Pritzker School of Medicine at the University of Chicago, Feinberg School of Medicine - Northwestern University, Mayo Clinic Alix School of Medicine, the Cleveland Clinic, Louisiana State University Health, USCF School of Medicine, Stanford University School of Medicine, Yale Medical School, Rush University Medical College, Weill Cornell Medicine, Loyola University Medical Center, UPMC Magee-Women's Hospital, and others. Dr. Sandhya has treated physicians from a range of different sub-specialties - otolaryngology; cardiology; endocrinology; pain management; orthopedics; dermatology; ob-gyn; family medicine; emergency medicine; spinal; oncology; neurology; interventional radiology, and others in rural and urban settings. Dr. Sandhya also has experience with the unique challenges encountered by physicians of color. For Dr. Sandhya's brief resume click here (or scroll below).
Schedule your appointment to share your story
Physicians can seek services for a variety of concerns, such as:
Anxiety, rumination, self-doubt, and worrying about the future
Grief and bereavement
Anxiety during preparation for Board certification
Self-worth and insecurity
Managing difficult personalities in the work-place
Coping with the fear and stress of litigation
Challenging interpersonal communication (such as bullying behaviors) with superiors or subordinates
Managing the fallout from a family member's suicide
Navigating challenges in lack of organizational support
Difficulty disengaging from the traumas of one's patients
Dr. Shaifali Sandhya is a US and UK-trained psychologist and will be leading the appointments. She is educated at The University of Chicago, US and the University of Cambridge, UK. She is also a highly trained couples and family therapist. Having worked in different medical settings, Dr. Sandhya is familiar with the pressures medical professionals undergo and the continuous care they need to re-focus their ambitions and hopes. As a former professor of Clinical Psychology, she is able to break down complex ideas into easy-to-understand and digestible forms for you to drive small or big transitions in your life.
We invite to you to take a pause in your life to invest in reflection on your inner life.
Please email our office or fill out our appointment form for more details. Scroll below to learn more about the initial appointment.
CODE BLUE OF MENTAL HEALTH: PHYSICIAN STRESSORS
It is stressful being a student and the stress does not end when you're a physician
Even for the most successful student, medical school is not without its stresses. Today's medical students, residents, fellows, and physicians face a slew of stresses that can be all-consuming. In order to survive, and thrive in medical school, they face prolonged challenges. For doctors-in-training today, such challenges can range from: managing the stress of matching with a good medical program or specialty; traveling to hospital sites in different cities for interviews; adjusting to different cities during internship, residency, or fellowships; lack of sleep with 24-hour and 36-hours rotating shifts; following an arduous clinical day, documenting patients' progress in a consistent and detailed manner; passing the many STEP exams; providing patient medical synopsis to one's attending and the team regularly; being on call and supervising residents'; and, managing one's patients' emotional health and one's own while routinely being exposed to the traumatic events. The list of stressors for physicians is unique, long, and can be self-isolating.
The Gendered, Racial, and Political Worlds in Medical Settings
As physicians, medical professionals discover that when their training ends, the intensity of their professional lives does not end. Emergency rooms, ICU's or hospital settings can in themselves be microcosms of politics, race, and gender where the outside society may be reproduced. Physicians may face a hard time negotiating the gendered or political worlds of hospitals or academic departments with its share of difficult personalities. Female physicians may find additional challenges in managing how factors such as gender, minority status, skin color, and so forth may determine others' perceptions of their clinical expertise before it is too late. They may find themselves at a loss to handle misogyny or toxic "whisper campaigns" that may conspire to sometimes, even ending their careers. Despite performing hundreds of operations, others may struggle with anxiety after a medical procedure gone awry, self-doubts about their clinical judgment, or guilt at surgical complications, years later. Therapy at critical junctures of one's career to navigate difficult personalities or politics by acquiring new skill-sets can often prevent sometimes, years of self-recrimination, dejection, or suffering.
Loneliness, Irritability, Shame & Guilt
It is especially stressful to be a physician. There is little time left for self-care, one's relationships, and/ or investing in one's own mental health. During these strenuous periods, neglect of one's care can result in alienation from friends and family, burnout that is insidious, chronic, and damaging to one's morale, and impede personal growth.
Loneliness, dark thoughts, and rumination can be a sign of depression, and can affect sleep, energy levels, motivation, productivity, and life's goals; negative spirals of feelings, being trapped in rabbit holes of negative thinking, and feeling like the "shoe will drop any time" can prevent a healthy work-life balance or personal growth. Even when medical professionals can recognize signs of depression or burnout in themselves, it is often too late for them to do anything about it. Experts estimate about 300 to 400 physicians in the U.S. take their lives every year. However, while physician burnout is serious but it does not begin to capture the silent spiral downhill in a doctor's life. In our coaching sessions, you will gain practical tools of healthy coping, engage with understanding your psychological triggers affecting your personal and professional quandaries, and immerse yourself in removing psychological barriers to your drive, self-worth, and success.
PROCESS OF CURATING YOUR JOURNEY STARTS WITH ONE STEP
What does the initial consultation in coaching look like?
Quality: There is going to be a lot of talking in therapy - but with insight, reflection, and purpose - so that you can connect the many dots of your life. Facilitated by insight and interpretation, it is a different kind of chat than you would have with a friend or family member. You may feel different emotions post-session and those emotions may evolve as you move beyond the superficial to unravel greater depths within yourself.
Duration: The initial couples consultation session lasts 50 minutes. A therapeutic hour is generally, 45-50 minutes.
Homework: As coaching progresses and based on your unique journey/ history, the coach may collaborate with you to determine your favorite learning method and offer recommendations of books, articles, exercises, questionnaires, and other resources enjoining learning through your different senses.
Hands-on Skills: You will also learn useful techniques such as but not limited to, active listening skills, role-plays, perspective-taking, reframing, and so forth to expand your relational lexicon, and strategies you can utilize to have productive rather than counterproductive conversations with yourself.
Family Blue-Prints and Baggage: We may work together to create family genograms or "family blueprints" to understand how the past may be unconsciously affecting the present if you feel ready. Above all, you hold the reins to the pace you feel comfortable with.
You control the pace of our work together, how much you want to share and what you want to share. As you gain good tools that restructure your habits and retrain your mind, you will also find that the effects of good therapy can last years after therapy ends. Based on your life history and what you've shared, a good therapist gives you all the data, but you still make all the decisions.
Feeling scared or shy? It will be OK. Your coach is a warm and experienced professional who will ask you the right questions to draw you if words fail you. The therapeutic space is 'your' space where one baby-step at a time, you will be re-writing your story.
Discrete, Confidential, and Short-Term Psychotherapy for Physicians
There are many practical and personal reasons why doctors who invest time and care in the health of others, push their own medical health under the rug:
Stigma in the medical culture and/ or the fear of hurdles in licensing
Lack of wellness and support groups at their workplace
Long waiting times to see a psychologist or a mental health care professional
Lack of time and sleep to focus on self-care
Discounting one's mental health until it becomes a huge issue
Absence of a support network
It is okay to seek therapy for yourself or your family member. It is important to know that there are other medical professionals like you who have been in similar situations and whom therapy has assisted in sharpening goals, developing supportive networks, and achieving fulfilling relationships. You may read some of their stories below.
VIGNETTES (*names/identifying details have been changed)
Kevin: The Physician Addicted to Worrying
Kevin describes himself as a direct, matter-of-fact physician with meticulous attention to details. "I'm not a feelings kind of guy. I'm not usually soft or sentimental," he says. But when it comes to patients, "I worry about them. I worry if they don't come for follow-ups, I worry what my patients think of me. I worry about getting sued and even the smallest encounter makes me ruminate. I make it my responsibility when patients are non-compliant. My guilt never leaves and each moment of each day, I suffer that I've somehow let someone down." Kevin has been on antidepressants, ketamines, and hypnotherapy but is still at a loss. Lately, it seems things have got worse as he is unable to get a restful night's sleep, has gained weight, and stopped enjoying the activities that previously brought him joy. With coaching, Kevin starts to explore how his feelings about his patients have roots in a past childhood trauma. As he explores his guilt, helplessness, and inadequacy underlying the worries, the initial phases are challenging for Kevin. He learns, slowly and painfully to combat a life-long habit through the importance of healthy self-talk, implementing good patient-doctor boundaries, and continued analysis of the past concerns.
---50-years old, Family medicine physician
Miller: The "Bad-Ass" Surgeon Flummoxed by Empathy Towards Problem Patients
Dr. Miller is considered a "bad-ass" by many in a coterie of other highly-skilled surgeons, in the face of his many miraculous saves of patients where others may have floundered. He has performed nearly 20,000 diagnostic and interventional procedures. His celebrity status extends outside of the intensive care unit and he has authored or co-authored hundreds of articles and peer-reviewed clinical research papers. "My biggest problem is that I do well when patients really need me" shares Dr. Miller, "but those are not the patients I am judged on." Dr. Miller seeks therapy as his lack of bedside manners have had many a patient irate enough to lodge complaints against him. "I'm impatient when patients challenge me and then, I become short," says Dr. Miller. "Problem patients" have dogged Dr. Miller from one hospital to another and have become a problem in itself. What brings Dr. Miller to therapy is a desire to be more patient-centric and developing more empathy for his patients so that he has fewer complaints. As therapy progresses, Dr. Miller explores critical incidents in his past that affect his biases and subconscious frustration with his patients.
-47 year old, male surgeon, speciality field
Patricia: The Discontented Top Doc Acclaimed as "40 Under Forty"
Patricia has published many peer reviewed scientific articles, chapters, and recognized as of the top doctors in her field and state due to her pioneering work in the area of orthopedics. Yet, she struggles with a deep sense of disappointment in herself and a longing to excel. "I have unrealistic expectations of myself. I want to be a better surgeon, a better mom, a better wife, a better daughter... In that I'm constantly second-guessing myself and driving myself... 'Did I miss something? Did I forget something? Is my home clean enough? Did I do enough..?' So much is always spinning in my head. I spend 90% of my time reducing others' anxieties. I tell my children 'It's going to be ok,' I tell my patients,'You're going to be OK,' and I tell my family its "Going to be Ok.' Somehow when I say those things to myself, they just don't stick.' With coaching Patricia allowed herself to process her parents unrealistic expectations of her when she was growing up. With her new found self-awareness, Patricia says she "realized I was trying to raise my children with the unconditional love that I did not get growing up. There were always conditions attached to everything I received otherwise I would be disowned." With coaching Patricia leaned to maintain clear boundaries with herself and her loved ones and gradually letting go of the perfectionism that was causing her stress without lowering her standards.
— 40-year-old, Orthopedic Oncologist
Maggie: The Grieving Neonatologist
Maggie is a physician at a neonatal intensive care unit where she takes care of medically complex neonates or those who are critically ill. "I take it very badly when I lose a patient." When a baby dies, Maggie feels a resurgence of doubt within herself, "Families trust me with their most beloved thing and I cannot take care of it." For, "being in the situation where a baby is alive one minute and no more the next is psychologically very difficult to deal with." In the days that follow Maggie finds herself grieving over a life that could have been, and a baby who never got to live its full life. It is Maggie's responsibility to meet with the families for prenatal consultations and also in the aftermath of a baby's death. Often times grieving families themselves are "at a loss to understand what actually happened and there is a great deal of pain," adding to the level of stress and anguish. Over time, she reflects that unexpected deaths of newborns have manifested in a sense of loss, hopelessness, and revives her underlying insecurity of whether she can truly be a good doctor if she cannot save babies from dying. A major focus on Maggie's treatment plan was to separate her identity as a caring doctor from her false belief that she controlled all outcomes. At a systemic level, Maggie was able to implement trauma-informed communications within her team of providers and with families that bolstered her ecosystem with processing grief more effectively.
40-year old, Neonatologist
Lauren: No Room for Error in an Unforgiving Medical School
"The year I crashed with depression was the darkest year. I was operating as a subhuman. My memory went to shit. I became a different person. I was trying so hard to distract myself from getting tangled in ruminative thoughts that would spiral me into despair. I would sit with a book and could not turn the page as my mind would wander off. I couldn't talk to my family. My parents would say something to me that would hurt me to push or provoke me out of the depression. Dad was clueless. When I told him I was depressed, he said, 'You're fine.' I would ask mom to tell me one thing that was good about me that could cheer me up sometimes, and she would say, 'You're a good student.' She was not trying to be cruel but she couldn't understand. Medical school was rough with a general understanding that if you had depression you either dropped out or took a year off. It was a very, very awful time."
— 25-year old, Caucasian Medical Student
Stacy: The Return of Depression
"I'm suffering from an extreme case of burnout. I'm very anxious about my future and am constantly tired," shares Stacy, an Associate Professor, and an Emergency Medicine physician. Stacy graduated from Northwestern, obtained a residency at Stanford, and gained her fellowship at UCLA and "after that, I hoped that things would settle down but I constantly feel squeezed between demands at work and home. Finding herself depleted and "feeling like I didn't care about work," "writing incomplete patient cases," "not getting my notes completed in a timely manner" and "making only superficial contact with her patients," caused her to seek counseling. With coaching, Stacy was able to gain awareness of the return of the depression that she had experienced in medical school. With healthy coping skills and implementing some practical changes in her life, Stacy was able to manage her moods more effectively.
— 35-year old, Emergency Medicine Physician
Iman: Family Therapy for Physicians Run Down by Family Feuds
"We are a Muslim couple that has been married for five years with one child. Our relationship has been plagued with misunderstandings and miscommunications right from its start. At first, we thought it was our strong personalities and different expectations and that our relationship was just a work in progress, that things would ease themselves out eventually... Over these years, we have tried to connect but end up being fixated on what he or I did wrong in the past, how it happened and why it happened without not only resolving the issue at hand but also dredging up old issues... We have also tried pushing things under the rug but that has not worked...Our last argument dragged our families into it that resulted in a family sit-down where everyone got involved with emotions that ran high...as for the issue, not a dent was made on the original issue."
— 38-year old, Cardiovascular Medicine
Suicidal Ideation in Physicians
"My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and 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 underappreciated (sic). 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."
(Excerpt from: Hill, A. B (2017). Breaking the stigma - A physician's perspective on self-care and recovery. The New England Journal of Medicine, 376, 12).
Dr. Shaifali Sandhya (PhD., The University of Chicago; MA, The University of Cambridge) is a coach for physicians. She has assisted medical professionals in the US in successfully addressing their goals for improved health, personal relationships, and work-life balance.