In this podcast, Michael Myers, MD, and John Budin, MD, discuss Dr. Myers' recent book Becoming a Doctors' Doctor: A Memoir, as well as how the COVID-19 pandemic is helping medical professionals admit their vulnerabilities and steps clinicians can take when they have colleagues who may need professional help.
Read the transcript:
Dr. Budin: My name is John Budin. I'm a psychiatrist living with bipolar disorder, and I currently serve on the board of directors of the Depression and Bipolar Support Alliance. I've spoken extensively at national and international conferences and to medical trainees about my personal and professional life as a physician living with a mental health condition.
It's really my pleasure today to introduce my colleague and my friend, Dr. Michael Myers. Dr. Myers is professor in clinical psychiatry at the State University of New York Downstate Health Sciences Center in Brooklyn, New York. He's a world-renowned specialist in physician health.
Dr. Myers is the author or co‑author of 9 books. The most recent of which are Why Physicians Die by Suicide: Lessons Learned from Their Families and Others Who Cared, which was published in 2017, and Becoming a Doctors' Doctor: A Memoir, which was just released last month and which we're going to hear about in just a couple moments.
He's passionate about advocacy, lectures all over the world, and writes a bimonthly blog on physician health for the Psychiatry and Behavioral Health Learning Network. Welcome, Dr. Myers. Why don't we jump right in?
Dr. Michael Myers: Thank you. I'm delighted to be here, John.
Dr. Budin: Wonderful. Let's back up to an early point in your career. Were there professional or personal experiences that you had that led to your decision to dedicate your career to becoming a doctors' doctor?
Dr. Myers: Thanks for the question, John. They're both personal and professional. The professional ones, I'll start there, had to do with the fact that I had a bit of an unusual residency in that I got exposed to physicians as patients right from the get‑go. That gave me a little bit of experience while in training.
I had wonderful teachers and mentors for some of the unique needs that medical students, and physicians, and their family members have. By the time I finished my training then, I had a little bit of confidence in doing that kind of specialized work. That's the professional piece.
In my personal life, I was attracted to medicine for various reasons, which we all are as physicians. One of the things that was pivotal was the death of my roommate to suicide when I was a first‑year medical student. We were both first‑year medical students.
Although I don't think I realized that at the time, Bill's death really was the bedrock of two things. First, my going into psychiatry. Second, subspecializing in physicians' health. That had a lot to do with stigma. Bill's death was in 1962. The stigma associated with illness in medical students or physicians, and in especially dying by suicide, was unbelievably profound.
Dr. Budin: Great. Thank you. Dovetailing right on that, you devote a lot of your time in your book to the issue of stigma in the medical community. As you say, "Stigma is pernicious in the house of medicine." Can you describe for us what you've seen a little bit in this regard?
Dr. Myers: Yes, I use strong language when I describe the stigma associated with psychiatric illness in the house of medicine. The reason I feel that way is because it does come from a huge amount of professional/clinical experience.
In fact, if I were to leap forward to the research that I did for the book that you just mentioned in the intro, Why Physicians Die by Suicide, a lot of the content of that book was based in a qualitative research project that had began over 5 years ago interviewing the loved ones, family members, friends, colleagues of doctors who have died by suicide.
Not only did I have the stigma that I had heard about so much in my years as a doctors’ doctor, but I was now hearing it in spades from their family members. What I found most disturbing was that roughly 10 to 15 percent—it could be even a little bit higher than that—of the families that I interviewed, their loved one who died by suicide died without receiving any care whatsoever.
In other words, this was a physician who went from feeling well, healthy, went into some form of psychiatric illness, and then the next thing you know, he or she has died of that illness without ever speaking to a primary care physician, a psychiatrist, a psychologist, clergy, anybody who is out there to look after people with mental illness.
And I just feel that that's not right. In fact, it's such a paradox that we are the healers of others and in our hour of need how paralyzing stigma can be and prevents doctors from seeking life‑saving care. That drove me even more to put this book together, Becoming a Doctors' Doctor.
Dr. Budin: It's a story, unfortunately, that we hear too often.
Dr. Myers: Absolutely.
Dr. Budin: In addition to stigma, though, to ask a simple question that may, in fact, not have a simple answer, why do doctors have such a hard time allowing others to take care of them?
Dr. Myers: It's huge. I've been focusing on stigma but there are other reasons as well. That has to do with us. It has to do with the culture of medicine. If we look at us, that has to do with the fact that as we train in medicine, we learn about so many illnesses. Some of them are pretty frightening.
Sometimes, and when, and if we develop some symptoms, our default position is to go into some form of self‑diagnosis or whatever, as you know being a physician yourself. In fact, William Osler spoke about that, as the physician who looks after himself has a—now, I'm really stumbling over that famous quote—has a fool for a physician or something like that, that kind of thing.
Yet, we do it so commonly. What my point, though, is, is that we also develop an immunity to the fact that we're different than our patients. They like us to be well. That gets reinforced. We work hard. We often don't take the time to care for ourselves. Some of us who are attracted to medicine, too, seem to have this drivenness or this dogged independence as well.
As you well know, many of us have come from families that aren't lily white or perfect. The so‑called wounded healer, that's partly what attracts us to medicine. We're tough but yet we have this vulnerability. That's the part that we bring to the equation.
What is so interesting about it is that when we grew up as kids, our families take us to the pediatrician. We have a family doctor or something like that. But once we get all this training under our belt, it's almost as if we don't need that anymore, which is really kind of ridiculous when you think of it. The vast majority of doctors don't have primary care physicians. They like to go directly to the specialist if they go at all.
The other part, I won't belabor this, is the culture of medicine, which has a lot to doing with being tough, strong. Even though we've seen a lot of changes in that over the decades that we're able a little bit now to admit more our vulnerabilities and our humanness, we still have a long ways to go with that.
That's why I was hoping that a lot of that humanness will come out in this book. I'm trying to normalize it.
Dr. Budin: Thank you so much. Let me shift gears a little bit. You devote an entire chapter in your book to one patient that you call Dr. Z. This is notable. You speak painfully and honestly about him committing suicide, a very traumatic event for all involved including you. As difficult as it might be, can you share your personal and professional reactions when he died?
Dr. Myers: Yes. As you noted, John, the very beginning of the chapter, too, does give the preface to that as to why I chose to do that. I wanted this chapter to be detailed. I was very, very fortunate to be able to contact his sister who I met when he was alive but also at the time of his death. She gave me permission to, basically, be completely transparent about his care.
I still left out a lot of things, but basically this is a true story of a man who was my patient for so many years. Toward the end of the chapter, I do talk about my reaction to his death.
I've also used the story of Dr. Z in a lot of my other writings. I've used it a lot in presentations I've given in the treatment of psychiatrically ill physicians and how it is for us as doctors treating other doctors when we lose one of our own to suicide. What was unique about my situation with Dr. Z was that I never underestimated the magnitude of his illness.
You may recall from the chapter, I felt him pulling away from me, his family did as well. The other people treating him felt a similar sort of thing. Even when you have the sense that, "I wonder if my patient is going to eventually kill himself or kill herself," there still is this reaction. Yes, I was still shocked. I certainly felt a great deal of sadness for him.
I also felt sadness for his family, for myself, this type of thing. I had to spring into gear and remain in gear for quite a while. You will also recall I had this unusual situation where he left me a note. That came as a surprise. I haven't received notes. I've received one other note from a patient of mine who died by suicide. This is the second note that I had received.
The content of that note, which I mention in the book, is for me to take care of his family. I felt then that I had to honor his mother's request to say a few words at his funeral. That threw me into all kinds of existential as well as ethical quandaries.
With the help of so many of my family members, my colleagues, and friends, as well as my therapist at the time, I made the decision that I would say a few words about him at his funeral, which I did. I kept it respectful. I also mentioned too that I basically came unglued. I think that's the descriptor I used.
What prompted that was as I looked out at the mourners, I hadn't anticipated, although intellectually I should have known that, many of the individuals there who were friends and colleagues of his were people I knew, other physicians. Some were students of mine or had been students of mine. Many were current patients of mine. I felt naked. I felt exposed.
Even though I didn't identify myself as Dr. Z's treating psychiatrist, they knew. Yet, on the other hand, I am so glad that I was completely transparent. I felt that I needed that authenticity. That has sparked a lot of discussion in medical‑legal circles as to why I did that.
Most psychiatrists said that they would never ever do anything like that. It's a very interesting take and I think that controversy will continue on this matter.
Dr. Budin: As you say, your memoir is written with an honesty, and transparency, and an authenticity. It comes from such a personal space. You are to be given great credit for that. In that regard, you write about accepting the fact that you're gay late in life. You describe yourself as, as you said before, "a wounded healer."
I want to quote something that you wrote a little bit down the road in your book. You said, "Although this is my ninth book, it is the first one with the authenticity and honesty that a true memoir demands and a reader deserves.
"About two years ago when I began to muse on this subject, I became aware that I could not chronicle my journey of becoming a doctors' doctor without disclosing this essential piece of my own story." Can you share a little bit about that?
Dr. Myers: Yes. I felt and I feel exactly that, that I needed to come out publicly about my gayness at such a late stage in life, at the age of 64. The details, of course, are in there. I didn't put in a lot of detail.
But yet when you write a memoir, you have to disclose some things about yourself that are relevant to the subject matter, becoming a doctors' doctor. That's why I chose to put it in with my editor's assistance at that point. That was a pivotal stage in my life. After 40 years of marriage, my wife and I separated, divorced, and I came out as a gay man.
What I also did in the book, as you know, in those few paragraphs, is to explain that this didn't come out of the blue. I had struggled with some same‑sex feelings way, way back in my early years of training. I was living in Los Angeles then. I began to experiment, so to speak. At that time in our society, 1967, 1968, homosexuality was a disease, a perversion, a deviation.
Then we moved into DSM taking it out and then into ego‑dystonic homosexuality and things like that. The personal piece that I shared in the book at that time had to do with the fact that when I began to recognize those feelings and actualize them, I didn't feel good.
I knew no gay doctors. I was at a crossroads. I thought, "If I continue down this road, what's going to happen to my medical career?" I shut the door on a closet that I'd never fully left and slammed it shut. It was shortly after that that I met a woman who became my wife.
All of this stuff that I'm talking about now came out on our first date, and that began a very long and largely rich and healthy marriage for a long, long time with two beautiful children, etc. But that's the backstory to that. That was, I would say, the most authentic piece that had to be included in this memoir.
Dr. Budin: Thank you for sharing your story so honestly. I think it's one that can help so many, and I give you great credit. It is a reflection of your courage to be so authentic, and genuine, and true to who you are.
You have spent a lifetime, not just treating doctors and medical trainees, but making it your professional goal to educate your colleagues on the topic of physician health. In that regard, let's say you see a colleague of yours who notices a fellow doctor or trainee who seems psychiatrically unwell or suffering psychologically, what advice would you give them?
Dr. Myers: My advice is always the same, do something. You have to do something. As you know, John, there are many examples in the book where I had to do that myself. I learned that a long time ago, probably maybe part related to Bill's death back in medical school or whatever, rack my brain.
Could I have said more, done more, might I have prevented his death by suicide. I don't know. I was the last person in our class to see him alive, but I've learned the hard way. There's a lot of lessons that we learn as physicians and as human beings as we go through life.
The one thing that we do know too is that it's not easy for us to just ask for help. If we observe a colleague in our midst who seems different and changed in many or some ways, it's very important that we reach out to them in a very private, confidential, one‑on‑one way, and just ask that essential question, "Are you OK?" or "Can I help in any way?"
There's some guidance to this but there's no cookbook or anything like that. Because what it is, it's our reaching out, it's our humaneness for that colleague in medicine that is key, when we do that without judgment and with assistance.
The second part I want to just add to that, because I learned this years ago making a very important documentary videotape on physicians living with depression, one of the speakers was somebody who was given the names of professionals to go see because they realized indeed she was depressed, but what I learned, was how impossible it was for her to do that.
To make those phone calls when you feel so lousy, so dreadful about yourself. It's very, very hard to do. You feel ashamed, you're embarrassed, you feel you're bothering the person who you're calling, you're very sensitive to rejection.
That's why I always recommend that we help our colleagues by making those phone calls for them, or if they insist on doing it, at least we check back with them that at least indeed the person has sought help and is planning to do that. That's just a small snippet, John, to answer your question.
Dr. Budin: Thanks so much. Mike, as I read your book. I was a little surprised at something. I had the strong feeling that this is not just a book written for doctors, but one that could resonate with nonphysicians as well. I was wondering if you thought I was correct about this, and if so, how so?
Dr. Myers: Yes, you are correct about that, John. I had that in mind. In fact, my editor told me that from the beginning. He said to me, "Look, this is a book that I think has a larger audience than physicians themselves, and keep that in mind." That was very important, of course, for my prose. He was masterful at getting rid of the medical jargon, because it's universal in many ways.
I’m also, of course, hoping to attract younger mental health professionals to the field of physician health so that they too will reach out and make themselves available to their brothers and sisters in their hour of need.
Dr. Budin: Mike, as you know, clinicians can have a range of feelings and thoughts that arise when we treat our patients and you've spoken to that so eloquently today and in your book. You write about countertransference in your work. Can you define what this is for listeners who may not know what countertransference is, and just give an example or so from your years of treating doctors?
Dr. Myers: Thanks for that, John. This is especially important, of course, for those, you mentioned a wider audience. Countertransference, big definitions or small definition, it is basically what we bring to the table.
There's two parts to that. It's what we bring to the table because of our own life experience and things that we've examined in our own lives, and the conflicts, or the strengths, the vulnerabilities that we own.
Also, another form of countertransference is the way that our patients react to us or bring out things in us too that we partly own, but they nudge us to behave or respond in the way that we do. In a book like this, Becoming a Doctors' Doctor, I really tried in so many situations to really speak openly about the way this particular patient was making me feel.
That's why the vast majority of the stories in the book are disguised composite vignettes, which is the work of physician authors, with the exception of Dr. Z and also 3 other physicians who are very alive and well. I showed them the manuscript and I got their permission to tell their story as well in some detail. It really enables me to explain what was going on for me.
There was one woman in particular who was so suicidal for such a long period of time where really I shared a lot with the reader as to what that was like looking after her, but yet I did it with the blessing and with the assistance of so many of my colleagues, which was really, really nice and essential to have.
John, I hope I've answered your question, but that's that personal part of us that we use positively and in a strategic way in helping our patients.
Dr. Budin: Yes, you've answered the question beautifully. Mike, I have the sense that we could talk for hours and hours about your book. It is so compelling, such a wonderful read, I absolutely loved it. Why don't we finish on this?
There's a quote that's written by a poet, Adrienne Rich, that means so much to me, both professionally and personally as a psychiatrist living with bipolar disorder. She says, "What remains unspoken over time can begin to feel like it's unspeakable."
Now, you seem to say that when it comes to doctors with mental health problems that it's incorrect to conclude that these are things that in fact are unspeakable. We can indeed find the words, and as you say, we must do so.
You end your memoirs speaking the words for those doctors who remain voiceless and you conclude your memoir on such an optimistic note. Can you share with us why you feel so hopeful as you look forward?
Dr. Myers: John, just listening to what you just said, I feel gratitude to both you and Adrienne Rich for that wonderful quote, and also, it's true because we know that the world is full of individuals who, and not just in medicine, who feel so liberated now that they've told their story or they've begun to speak, they now have a voice.
I ended the book on a hopeful note because that is truly the way that I feel, and it has to do a lot with looking to the next generation. Those of us, when you reach a certain age, we look in both directions. When we look to the young, I just see so many exciting things, so many positive things. I love to read accounts of medical students who write first‑person accounts.
It's like, "Why can't we talk about our vulnerabilities? Why, in medicine, do we have to shut down our humanness?" Ones who say that somewhat defiantly, and I love to quote this person—although he's not a medical student, he's a middle‑aged career physician, he's somewhere in the book—he said, "I wear my depression on my sleeve. No one's going to make me feel ashamed." That's not just a statement of self‑disclosure. There's a sort of defiance too, which is just so powerful and so very, very important.
When I see that, when I see the research that's going on, and if there's any bright light in this pandemic, this is also doing something to physicians, whether they're attendings, or trainees, or both, it is humanizing us because we are truly all in this together.
Many of them are just speaking much more openly about their feelings that historically have been hard for doctors to do. As you know, John, I compared a little bit the COVID‑19 pandemic with the AIDS epidemic, that also forms a chapter in the book, and it's very different this time around.
Many, many years have passed, but there is something happening to physicians and I see it as a good thing. I think that our patients will be the benefactors as well.
Dr. Budin: Mike, thank you so much for sharing all that you did in your book, and I suppose even more so, thank you for being who you are. You present a story, your story, that is authentic and genuine, that is heartfelt. It's a marvelous read for both doctors and nondoctors. Thanks so much for sharing.
Dr. Myers: Thank you, John. I really enjoyed speaking with you today. I wish you all the best.
Dr. Budin: Thanks so much.