Herdley Paolini, MD, Illuminates Mystery of Physician Mindset

Editor's note: Names used in sample cases have been changed for privacy.

When emergency room personnel were ready to operate on a patient requiring immediate attention, the on-call anesthesiologist didn't respond to the page. Instead, the anesthesiologist who had just finished a shift reluctantly agreed to stand in.

When another patient needing surgery was rolled into the OR, the anesthesiologist hissed to the attending physician: "You'd better find Dr. Curtis!" After the second operation, the physician paged the anesthesiologist himself en route to the restroom. When he heard a pager beeping from a locked stall, he paged him again. It was no coincidence. Behind the door, hospital security found the missing anesthesiologist sprawled lifelessly beside the toilet, with a needle still stuck beneath the skin that contained narcotics. Nobody knew about his drug addiction.

On the other side of town, a highly respected pediatrician was seeing his forty-seventh and final patient of the day. Fatigued, he was irritated by what he thought was a mother overreacting to her daughter's minor indigestion or a virus that would soon pass.

Going home that evening, he thought about the last six months. His partner had left the practice to battle a terminal health condition, leaving a burdensome caseload until a replacement could be found. His 15-year-old son had admitted to using drugs after paraphernalia was found in his room. His wife was having trouble sleeping, and seemed clinically depressed. He felt so physically and emotionally drained that when his answering service called at 3 a.m. with the hysterical mother on the phone, he asked her to bring the child to the office the next morning. Before he could examine the child again, she was dead.

"We're shocked and saddened, perhaps even angered, when we hear stories like these," said Herdley O. Paolini, PhD, a licensed psychologist and director of Physician Support Services for Florida Hospital, and author of the book, Inside the Mind of a Physician, published in 2009 by Florida Hospital Publishing. "As much as we might like to reserve such stories for film and television drama, (these) are only a few of many physicians with tragic experiences.

During my years of counseling and consulting within the healthcare industry, I've seen both the hope that medicine offers to so many of us, as well as the complications that accompany its practice."

The cost of misunderstanding physicians is high, Paolini said.

"While most healthcare administrators intuitively understand that physicians play a key role in determining an organization's bottom line, many don't grasp the full extent," she said. "Physicians occupy a central place in healthcare delivery and greatly impact treatment outcomes, litigation risk and processes, safety culture, patient satisfaction, staff satisfaction and retention, and funding and charitable donations.

All these factors influence the bottom line, competitive advantage, and survivability of not only physician practices, but also larger organizations where physicians practice. In fact, in an environment of rapid and highly consequential high-stake changes, we can be sure that partnerships with physicians and physician health, engagement, and alignment will determine survival, market success, and integrated, cutting-edge delivery of healthcare."

Because the medical school environment encourages survival of the fittest, it's not surprising that specific aspects of personalities of physicians-in-training are "split-off" as a coping mechanism, said Paolini.

One physician told her: "Medical school is, in many ways, like boot camp—patriarchal, militaristic, and designed to strip you of your individuality and turn you into a physician clone, devoid of personality, emotion or creativity. Always trying to catch up, you devise ways to try to make up for lost time. You shorten your conversations with friends and family until you virtually no longer talk with them. You limit your daily routines until they're unfamiliar. Before you know it, little of your precious life remains."

Some physicians mask their inner turmoil, like A. Johnson, MD, who is known around the hospital as a model doctor. Warm and caring toward his patients, he is courteous and kind to nurses and non-clinical staff, attends all medical staff meetings, champions for fellow physicians, and takes all consultation requests. As a result, he works 16 hours a day, most weekends, and seldom takes vacation.

"We praise and give accolades to this type of physician," said Paolini. "We're unaware that his wife is suffering from a clinical depression and his daughter has been hospitalized due to an episode of major depression. We don't know that he's lost the joy he used to have and that he secretly imagines himself walking away from medicine."

The current environment of medical practice has magnified underlying challenges, said Paolini.

"The costs, both psychosocial and financial, have increased, while the rewards have diminished," she explained. "Effects include increased dehumanization of healthcare delivery and the physician-patient relationship, in particular."

The future of healthcare depends on providing a healthier workplace for physicians, "where the dilemma of being human and being a doctor can be entertained at the same time," she said.

"I can only imagine what medicine and healthcare delivery would be like," said Paolini, "if we were to admit to and account for the most basic human needs of physicians; if we were to nurture wholeness in their training and their practice of medicine; if we set up practices and hospitals with the understanding that medicine cannot heal without melding the tasks of medicine with the relationships among the people involved, without blending competency with compassion."

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