Physician PTSD—5 tips to disrupt the cycle

Pamela Wible: Today we’re gonna talk about physician PTSD. Sydney, you’ve been working with physicians with PTSD for nearly a decade and just came back from a personal retreat where you spent four days with a very successful emergency doctor suffering from PTSD. I’m really curious what you’ve learned.

Sydney Ashland: What I’ve learned is that it’s a far more pervasive issue than anybody is even talking about. We hear so much about physicians living very highly-stressed lives with a lot of pressure, but we really don’t talk so much about the fact that many are living in secrecy with their PTSD, because it can be a career killer if you acknowledge that you’re suffering with something like that. The biggest thing I’ve learned is that it’s a far more serious issue that is very pervasive than I ever knew.

Pamela Wible: So underreported and not really talked about in medical circles. I didn’t even realize this was a problem until I started hearing from physicians who had very clear PTSD symptoms on the phone as I was talking to them on my suicide helpline. Looking back over the last 10 years, do you notice any themes as far as what specialties are at highest risk?

Sydney Ashland: Highest risk are emergency physicians, anesthesiologists, and surgeons. Those are the three that I most commonly work with that have recurrent or even complex PTSD symptoms. Many physicians hide their PTSD under the labels of anxiety or OCD. You’ll hear physicians joke. “Oh that’s my OCD.” Well, it’s not really their OCD, it’s their PTSD—their trauma. I listen carefully now when somebody starts talking about anxiety, panic attacks or OCD, because often those are covers for post-traumatic stress disorder.

Pamela Wible: I’m sure you’re aware of my complete disgust for the term burnout, which I also think is a cover for a lot of the mental health issues that physicians are legitimately suffering from.

Sydney Ashland: Exactly. When I started to talk I was going to say we’re used to hearing about physicians who are burned out. I don’t want to perpetuate that phrase so I avoid it. It’s a word that everyone nods their heads and approves of, yet if you start talking about the very real life-altering and disruptive energy of post-traumatic stress then people get far more uncomfortable.

Pamela Wible: What is it about medicine that causes this PTSD, do you think?

Sydney Ashland: First and foremost, a lot of medical conditions in the ED and OR are trauma-based. You know, someone gets injured, someone is severely ill and so there’s a lot of trauma in the family and internally with the patient when they’re in a high-drama situation. Makes sense that those traumatic situations can induce a trauma response in physicians.

Another cause is the training process for physicians. They are habituated in treating themselves poorly, being expected to operate at tip-top standards when your sleep deprived, hungry, haven’t relieved your bowels in a few days to get graphic. You know all the things that physicians put themselves through in order to be at the top of their class or be acceptable when it comes to rotations or residency. When you treat yourself poorly, you’re not as resilient. You don’t have the internal resources and tools at your beck and call and so then when a traumatic situation presents itself, you don’t have the resources to deal with it and you get sucked into that trauma response where adrenaline starts flowing, your reptilian brain kicks in and you’re in the fight-or-flight or freeze mode.

Physician with residency-induced PTSD shares her experience below. View full interview here.

Pamela Wible: So it’s definitely the exposure to suffering and death in patients, especially when there’s unpredictable trauma like gunshot wounds, car accidents (which of course as a family doc I’m not exposed to such horrific suffering and death). When doctors are dealing with mangled bodies and potential death of toddlers during their shifts—it is traumatic. You’d have to be like a sociopath not to feel some of this pain. And medical training is rampant with human rights abuse where you’re working these people the equivalent of two to three full-time jobs without work-hour restrictions that allow them to sleep, eat, and go to the bathroom. Compartmentalization takes over through the medical education process in order to succeed at work. They’re hyper-compartmentalizing emotions and their home life and all these things and so I think sometimes it only takes one next gunshot wound or one next traumatic experience to kind of put them over the edge, yet everyone has seen them as sort of normal up until that point, right?

Sydney Ashland: Right. I’d say they’re very close to the tipping point at any one moment and so it doesn’t even take the perfect storm to bring this into a profound reality for them, where they have a trauma response. And so yes, exactly as you’ve described it is perfect.

Pamela Wible: In a bit I want you to address some of the things that physicians can do if they’re suffering with these symptoms, but I’m very curious if you find that nurse practitioners and PAs and other health professionals are at risk as doctors are? Are they in a unique category themselves?

Sydney Ashland: Depending upon where they’re working. I have definitely spoken to nurse practitioners who work in the ED or the OR who are more prone to having PTSD as well. However, I would say that most PAs and nurse practitioners and other auxiliary staff that are right there in the traumatic event don’t have the same level of responsibility as a physician. That’s not to minimize the effects that seeing a gunshot wound or a child abuse case. That can be traumatic for anyone and everyone. But if you are in a position where the buck doesn’t necessarily stop with you, then you are less likely to feel isolated and in that isolation have a traumatic response. But certainly there are nurse practitioners and PAs who work in the OR or ED who have PTSD as well.

Pamela Wible: The training regimen for nurse practitioners and PAs is sufficiently different than physicians in the length of their training and again, the responsibility that they have so that at least at the retreats that I’ve held when I’m sitting for five days with an array of physicians, medical students, nurse practitioners and PAs, I definitely notice a difference between the level of PTSD in medical professionals. The longer that they’ve been in medicine it seems the more traumatized they are versus let’s say first and second-year medical students and the nurse practitioners who even if they’ve been in a career for a long time seem to be sort of overwhelmed hearing the traumatic stories of physicians in the room.

Sydney Ashland: I’d say for nurse practitioners and PAs their training is much less toxic and so they may suffer more from PTSD as a result of the dysfunctional environment in a hospital setting. For example, a malignant program with lots of toxicity and politics and they have a hard time maneuvering those waters while at the same time dealing with really high-risk medical situations. Then they’re more prone to the PTSD. Other non-physician training programs are much more benevolent and much more respectful in many ways for the people being trained so they don’t come with the same level of stress that most physicians do.

Pamela Wible: In what ways are you available for physicians, PAs, nurses, even EMTs who might be suffering from PTSD?

Sydney Ashland: I’m smiling from ear to ear because I am available in so many ways. I’m really committed to meeting people where they are at. I often have Skype sessions or phone sessions with people at very early hours or late hours depending upon what their time zone is so that I can accommodate them. My work life is very unpredictable and erratic and I like it that way. During midday when other people are in the office I might be out taking a walk, and then at the end of my day or early, early in the morning, I’m engaged with people who are really suffering with PTSD so that I can accommodate their hours. I also work on the weekends, but I am so accommodating. I have people who text me, people who email me so that we can stay in close communication, because I think that’s very important. PTSD is not something from my perspective as a physician coach that can be treated with once a week, 50-minute session in the therapist office.

Pamela Wible: PTSD is not really a scheduled condition.

Sydney Ashland: Exactly. And I often require people to be seeing a therapist or psychiatrist so that they can have medication if necessary or have a licensed professional dealing with them in their hometown environment, but as the coach and consultant that I am, what I love is my flexibility to be available so that I can get a text where somebody is really struggling at work and getting ready to go into OR. Can you help me find my center? And I’m right there. I’m on it. I’m either texting, I’m emailing. I even have someone who is stressed out enough that talking or emailing, all of that feels like too much pressure and so they’re writing me letters from Canada and it just tickles me because that is meeting them where they’re at, meeting them where their need is and so I’m happy to work with within anyone’s comfort zone, because that’s the way we need to treat PTSD.

Pamela Wible: And you’re actually even available to do a house call halfway across the country for multiple days at a time, right?

Sydney Ashland: I’ve done several personal retreats where sometimes it’s helpful for me to be able to come and actually see the workplace environment, see the home environment, especially for those people who have tried a lot of different interventions that don’t seem to be working. They’re on their third therapist and on FMLA. They’re really struggling to get back again and to really be able to see up close and personal what’s happening and schedule throughout the day, sort of, a care plan as it is for them to be able to take care of their needs before they get into a triggered response. So, they can slow down their life in such a way that they begin to notice the nuances of anxiety building and that trauma response being triggered.

Pamela Wible: I think you even told me that during the last personal retreat you actually attended the therapy session with your client, right?

Sydney Ashland: I did.

Pamela Wible: With her.

Sydney Ashland: I did. Yeah. And it was awesome. Their therapist was able to understand what my approach was and the resource that I could be, because therapists can’t be available 24/7 to talk somebody through going into the OR when they’re in cold sweat and hyperventilating. But I can really help with some of the tips I’m gonna give here in a few minutes with physicians finding that core place where they’re calm and where they can continue to move forward.

Pamela Wible: Before people hear about some of the tips that you have for them, I believe that everything that you provide is confidential. No paper trail. You’re not entering any of this into an electronic medical record are you?

Sydney Ashland: No, I am not. And I think that’s the beauty of me being a resource that is off the grid. I’m a coach. I’m a consultant and therefore, they don’t have to worry about mandatory reporting or that this is gonna get back to their supervisor. Certainly, I am wise enough to help people determine when they’re really at risk of hurting themselves or where they may be having intrusive thoughts that are desperate. Of course for sure we need a therapist and/or psychiatrist as a part of the team, because I think that’s another thing that’s really helpful with PTSD is to have some support because so often physicians work and live in isolation and so if you have a team that you know are all working on your behalf to help you heal this trauma, then it’s incredibly comforting and can make the difference.

Pamela Wible: So what do you actually tell doctors that say they only have a brief phone call with you, let’s just say? What are some practical tips that they can walk away with and actually implement to stop their PTSD symptoms?

Sydney Ashland: I have many tools that I’m happy to share with people. The top five general suggestions is first and foremost—don’t keep it a secret. You have to tell someone, whether that’s a spouse, a best friend, somebody you trust. Bring it to the attention of your therapist in a new way so that you’re not just there sort of processing generalized stress. You’re actually acknowledging that it’s at the level of PTSD. That’s number one.

Number two is having some centering and grounding practices in place so that you can become embodied again rather than what happens in that trauma response where you sort of leave your body and your in this very activated place where you can’t think clearly and our heart is beating fast, your breathing is shallow, you’re feeling a little bit confused or disoriented or feeling impulsive like you have to get out of the situation. I have some really helpful centering and grounding tools. I know Peter Levine, who is an expert in PTSD from Walter Reed Hospital, has some great recordings that help with centering and grounding as well.

Number three is slowing down the trauma response. Everybody wants to get rid of it, but getting rid of it is not the answer, because it’s really impossible to just will it away. What you need to do is really slow down the response so that you can begin to notice the nuances of what is it that exactly triggered me? Now that I’m triggered or activated what am I doing? What are the intrusive thoughts? What are my back doors that I fantasize about in order to get through? Once we slow it down, it’s sort of like stress eating. Those people that have found themselves in the kitchen eating an Oreo and they don’t even remember walking into the kitchen. How in the world am I standing here at the kitchen counter with an Oreo in my hand? Well, if you slow down that process so that you begin to notice every time you eat in your life, you will notice that you’re walking across the kitchen floor, that you’re reaching for the cupboard door, that you open the cupboard and pull the Oreos down and at any time in that process you can make a different choice. Well, it’s very true with PTSD as well. If you slow down the process and really pay attention to your center, your core, and begin to use some of those awarenesses to notice what’s happening, then you’re far more successful at not necessarily even needing to experience the full blown activation, but instead being able to disrupt it and not have a full blown event.

Number four is differentiating the physical versus the emotional response, because they’re both going on. Once you become aware of what’s happening physically versus what’s happening emotionally, then you can deal with each side of that coin.

Finally disrupt the PTSD cycle with specific interventions. And those interventions are unique to each person, because what activated this, what caused it in the first place, why we were susceptible to it and then deciding what is the appropriate intervention so that you’re not only slowing down the process, centering yourself, but you’re able to disrupt the process and bring in something else. It’s not about releasing PTSD, it’s about bringing in other tools and interventions that will disrupt the pattern and help you create a new pattern that then loosens the hold of PTSD.

Pamela Wible: That’s awesome. And I bet you’ve seen a lot of physicians very appreciative of your efforts and then able to maybe turn their life around and improve not only their professional lives, but probably their personal lives as well.

Sydney Ashland: Absolutely. Because a lot of times family members are aware that mom gets really quiet or dad disappears or it may be that you get irritated in your response to the disruption. And so people are aware that something is going on and they often then sort of walk on eggshells or try and ask questions. That only makes it worse because most people don’t wanna talk about what’s going on over and over and over in their head. They find that it only increases the stress of it rather than decreasing it. And so yes, it’s helpful with friends, with family. It’s life changing.

Pamela Wible: So if there is a husband or a wife of a physician or a physician themselves or maybe even a PA in the emergency department that would like to reach out to you, what is the best way for them to contact you?

Sydney Ashland: Best way is through my email, sydneyashland@gmail.com. Of course people also I know contact you a lot Pamela and sometimes you’re on the phone in the middle of the night helping someone. They can contact you if they’re in the midst of a crisis and wanna talk to someone and they can also contact me. Email is just the best way, because I have a fair amount of scheduled appointments and my schedule is erratic and so if somebody is just trying to call me every day at 4:00 PM they might not reach me, but if they send me an email and I find out what their schedule is, we will find something that works. Also my website is sydneyashland.com.

Pamela Wible: But if they have an urgent need or they’re really in the throes of PTSD.

Sydney Ashland: Then email me.

Pamela Wible: Squeeze them in urgently the same day sort of thing?

Sydney Ashland: Right. Oh, absolutely.

Pamela Wible: Okay. And I am also available as everyone I think knows 24/7 as long as I’m awake to answer and respond to anyone’s calls for free with physician mental health issues. So, thank you very much for sharing your insights and I look forward to having more people get the help that they need so they can practice medicine the way they always intended. Medicine is a team sport and physicians cannot approach this in isolation. To be a healer, we’ve really gotta come together and help each other.

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4 comments on “Physician PTSD—5 tips to disrupt the cycle
  1. Anonymous says:

    Pamela,
    You continue to AMAZE and INSPIRE me with your selfless dedication to my peers. I am currently sharing Sydney’s and your advice with a dear friend of mine who is suffering from PTSD from her high risk field, and honestly, an amniotic fluid embolism case that she had zero control over. You are a blessing! Thank you!

  2. Play tennis, any social sport, and engage in regular communal prayers or worship gatherings. Communal games and worship have been key stress-relievers for centuries if not millenia. A racket sport, one friend said, is a healthy psychiatrist. Tennis did not keep a troubled medical friend of Dr Abraham Verghese from suicide, but it may have enabled the MD help others for many more years before the end. For retiring MDs, we must fight fully to preserve the doctor-patient relationship, restore patient choice and freedom, and restore practicing PHYSICIAN voice and leadership into a deteriorating, unnecessarily costly and burdensome health care system before giving up our lives or the sinking ship. Bless you, Dr Pamela Wible, MD, for all the work you do helping us through these troubled times.

  3. Med Careers says:

    It is really helpful to have such knowledge with information that is relating to healthcare. Letting yourself feed with such information will really help you with the current issues relating to health and you can also use it for future reference. Thank you for sharing this information!

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