Physician Health Services uses coaches and counselors to help doctors protect themselves. In today’s changing world, now social media has been added to MD career risks.
This podcast is an episode of Patient Safety Updates. You can find other episodes and subscribe using the links to the left.
- Steven Adelman, MD
- Gail Gazelle, MD, FACP, FAAHPM
- Betsy Williams, Phd, MPH
Physicians seem to be encountering new obstacles that create trouble in their professional lives. Existing services that were designed to help doctors struggling with addiction are now expanding to address use of social media and workplace behavior. Where professional intervention once focused almost exclusively on drug and alcohol abuse, it is now being called upon to deal with inappropriate sharing on Facebook, hostility, or lack of collegiality at work. Dr. Steven Adelman is the director of Physician Health Services “PHS” at the Massachusetts Medical Society. PHS provides support, evaluation, and oversight of various health interventions when doctors are referred to them for a problem.
“The pace of work has increased in healthcare. So doctors are pedaling faster and faster just to get the job done. On some level I would say every human being has a boiling point. Some people’s boiling points are higher and some are lower. And many factors may go into where a certain individual’s boiling point is.”
Societal change is another factor. Dr. Adelman says co-workers who may in the past have kept quiet, are no longer willing to stand by. Reporting tools make it easier than ever to raise their hand. Even the way that medical care itself is delivered changes tolerance levels. The freedom to resist getting help is not there like it once was.
“I think a lot of physicians who completed medical school in the 60s and the 70s and the 80s were used to doctor as top dog, doctor as the head honcho in the hierarchy, a kind of hierarchical, top down approach to the team. And I think the teams truly are flatter and in that environment the doctor really is meant to be more responsive to the input and needs of other members of the team…but does not have the same level of absolute authority that physicians may have had in the past.”
Adelman’s service is funded in part by the major malpractice companies in the state, including CRICO. PHS handles 500 cases every year and helps doctors get back to health in delivering top-notch care to patients. It may involve a few sessions with a local counselor, or it may mean going to a week-long assessment with interventions and monitoring.
“Overall, I would say we help five overlapping populations of doctors, if you will, those with drug and alcohol issues, those with major psychiatric problems, those who demonstrate unprofessional behavior in the workplace, often known as disruptive behavior, those with neurocognitive challenges and other medical problems that may affect their ability to practice, and last but not least those with occupational stress and burnout. And the occupational stress and burnout often contributes to all the other problems that I just mentioned.”
In recent years, Dr. Adelman says, social media has come into play.
“Whether you’re an adolescent or a young adult or a practicing physician, there are more ways of getting in trouble now than ever. …So here at PHS we have seen some physicians get themselves into some difficult situations because of cell phone use, because of texting, because of things they’ve posted on social media sites such as Twitter or Facebook or Instagram. And, as an attorney once said to me many, many years ago, don’t write anything in an email that you wouldn't want on a billboard in Times Square and I think the same thing applies to anything you post on a social media site, because it can ultimately end up all over the place and having unintended consequences that you never envisioned.”
One of the agencies that works with physicians referred by PHS to help with social media issues is Professional Renewal Center in Lawrence, Kansas. Betsy Williams is the Clinical Director. Her agency provides evaluations and treatment for physicians after a referral for performance issues, usually related to behavior and addiction. Williams says problems with texting or posting on Facebook fall under the category of boundary violations. The ease of sending an inappropriate message or photograph to a patient or a colleague is a key factor.
“For example, we have seen physicians who have posted pictures of themselves in the hospital setting at a party clinking beer bottles. Obviously it’s a problem to be consuming alcohol at your place of work, particularly when you are a physician and I think sometimes they don’t think about how public social media is, and they don’t think necessarily about all the consequences of that behavior.”
Williams says the nature of the problem arising from doctors using social media varies. An isolated incident may not be as worrisome as behavior that is part of a pattern. Yet, a single episode of enough severity—such as sending a naked photo—will probably raise a redder flag. According to Williams, even a well-intentioned behavior can back-fire because the physician is unaware of the negative risks.
“In regards to things like texting, I think that, you know, it is an easy way to get hold of patients, but of course there are things like HIPAA and confidentiality that individuals may not have fully thought of all the potential consequences of texting patients and including sensitive or potentially sensitive information in those correspondences.”
Dr. Adelman says Physician Health Services still sees plenty of referrals for drug and alcohol abuse. Its latest annual report shows that substance use disorders account for the second largest category of presenting problems. Behavioral problems overtook substance abuse in recent years as the most prevalent issue. But the models for referral, assessment, and treatment are similar. Dr. Adelman says that physicians are notoriously reluctant to help themselves when they’re in trouble.
“I think the traditional culture of medicine has created some unrealistic expectations that doctors have of themselves. There’s a selflessness which to a point isn’t a bad thing, but when you’re taking care of other people before you take care of yourself or in lieu of taking care of yourself, you’re at risk of sort of running your personal car into the ditch…”
One way to overcome hesitation in these areas may be to think of intervention as a form of coaching. The coaching model of improvement is moving into medicine from its foothold in business.
“The coaching model is a wellness model. What’s right about this person?”
Dr. Gail Gazelle is an internist and Assistant Professor of Medicine at Harvard Medical School. Dr. Gazelle helped found the HMS Institute of Coaching.
“..how can we bring forth what more of what’s right about them, bring out more of their strengths, bring out more of their understanding of who they are as a person so that they can realize that they have choices about how they react in situations? They have choices about how they kind of live with their own internal milieu. They have choices about how they respond to people in the workplace and that anger is but one means of responding. So it’s quite an opportunity for physicians who typically have never taken the time to look within.”
Most Physician Health Services referrals she sees are for doctors who have exhibited behavior in the workplace that’s been identified by their healthcare institution as problematic. But Dr. Gazelle says she sees plenty of physicians just seeking a better work-life balance, facing burnout, or even moving into leadership positions who want to enhance their coping and performance in an increasingly pressurized environment.
“The hallmark of successful coaching is that there are goals that are established, there is accountability for change, accountability that’s co-created with the physician client that really meets them where they are and then stretches them to change.”
From Dr. Adelman’s perspective at Physician Health Services, the best kind of intervention comes early—he likens it to calling for help putting out a 1-alarm fire, instead of waiting to put out a 5-alarm inferno. The most important thing is to preserve the contributions and talents of valuable clinicians, and reduce threats to their performance and to their patients.
“I mean the biggest issue in my mind is that ultimately physicians are human beings, and human beings have health problems, issues, addiction, psychiatric problems. So we need to treat ourselves at least as well as we treat our patients. If we don’t, then everybody suffers.”
Physician Health Services is categorized as a highly confidential peer-review program. Unlike some similar programs in other states, it is not part of the state licensing board. Instead it is a small non-profit, created under the auspices of the Massachusetts Medical Society. Individual doctors or their institutions can contact Dr. Adelman’s organization anonymously, and discussions are strictly confidential. The phone number is (781) 434-7404 or (800) 322-2303 ext. 7404. More information is available online, at massmed.org/phs.
About the series
Even in the safest healthcare setting, things can go wrong. For more than 40 years, CRICO has analyzed MPL cases from the Harvard medical community. Join our experts as they unpack what occurred and the lessons learned for safer patient care from the causes of these errors.