“Is there a way to provide mental health services to medical professionals under the guise of coaching?”
A colleague posed this question in an email voicing his concern about physician suicide. He asked me because I am a licensed therapist in addition to being a coach who specializes in physicians and healthcare-industry executives, and he asked because we’re losing more than one physician a day to suicide in the U.S.
My reply: It’s complicated.
Many physicians endure tremendous emotional and psychological stressors, and they often try to carry their burdens alone. This dogged self-reliance is one reason so many physicians experience suicidal ideation. Without question, a big part of the solution would be to get them talking to qualified professional listeners. However, as my colleague’s question implies, opportunities to break silence and isolation frequently languish between two professional listening industries: mental health and coaching.
On the one hand, the coaching industry has an incentive to avoid being classified as psychotherapy. This is due, in part, to an aversion to government regulation and an abhorrence of labyrinthian payer bureaucracies. The consequence of this avoidance, however, is that most coach training programs don’t train coaches to talk about suicide. Many advise their budding coach trainees to avoid going anywhere near anything even close to therapy. “Stay in your lane,” is the go-to phrase. Consequently, they’re producing an army of professional listeners, most of whom are afraid and/or undertrained to address the issues of physician depression, anxiety, and suicidal ideation.
While I don’t treat mental health issues when I wear my coach hat, a handful of my coaching clients through the years have talked about suicidal ideation, but they have done so because I asked them about it. I’m not afraid to ask, I know how to ask, and I know how to respond if they say yes. (Likewise for depression and anxiety issues.)
It would be helpful to train all professional listeners, including coaches, to ask about suicidal ideation, depression, and anxiety. Talking about these mental health issues doesn’t have to mean you’re treating them.
On the other hand, the mental health industry requires mental health professionals—with few exceptions—to pronounce their clients mentally ill. Understandably, many physicians don’t want to be proclaimed mentally ill, nor do they want the diagnosis and subsequent paper trail. (In the olden days, we saved the paper records for 7 years and then shredded them. Electronic mental health records are forever.)
World-renowned psychiatrist Bessel van der Kolk once described the DSM as a “worthless piece of shit.” While I wouldn’t go quite that far, I get Dr. van der Kolk’s point. Most physicians don’t have suicidal ideation because they are dysfunctional. Physicians are human beings, and many are reacting as we expect normal humans to react considering their circumstances.
The poet William Stafford wrote, I call it cruel and maybe the root of all cruelty to know what occurs but not recognize the fact.
The fact, in this case, is that physicians (and other healthcare workers) aren’t the problem. It’s no one’s fault. No one got up one morning and said, “Let’s create a healthcare system that often perpetuates moral hazard and burns out its providers.” But that’s what we’ve got. That’s the problem.
My Take: First, train physician coaches to ask about anxiety, depression, and suicidal ideation. Teach them the difference between run-of-the-mill issues (that we all experience) and serious clinical issues. Teach them to broach the subject of suicidal ideation, teach them what to do when the answer is yes, and teach them that “parallel coaching” can enhance mental health services and doesn’t have to compete with them.
Second, create DSM diagnoses that don’t imply mental illness but indicate people reacting to stressors as normal human beings do. Then require payers to reimburse for them. Physicians need professional-listening resources that don’t pathologize them and/or jeopardize their reputations and careers.
It’s not rocket science. Physicians have depressions and anxieties like the rest of us do, but they are immersed in complex, stressful, and often dysfunctional environments. And, disproportionally, they often—for a variety of reasons—try to tough it out alone. Many could use qualified professional listeners to help them break silence and isolation, listeners who won’t pronounce them sick or broken.
Brad Fern is a developmental coach who specializes in working with physicians, physician leaders, and healthcare executives.
Fern EPC trends physicians, physician leaders, and executives toward higher levels of complex thinking. Fern EPC (dot) com.
Suggested Reading: New York Times guest essay entitled “Why So Many Doctors Treat Their Mental Health in Secret.” https://www.nytimes.com/2022/03/30/opinion/doctors-mental-health-stigma.html