Avoiding the CRASH: When Toughing it Out Stops Working

By Steven Adelman, MD

The caped heroes in the accompanying illustration don’t need to shed their stethoscopes and white coats to reveal their true identities. We all know that doctors possess super-human skills. Armed with encyclopedic medical acumen, we relieve the suffering of thousands. We stay up late to finish our charts. We wake up early to go on rounds. Sometimes we skip meals in the course of our long and demanding days, doing whatever it takes to get the job done. It works until it stops working, and then …CRASH!

We physicians have been acculturated to tough things out — to endure hardship and overcome adversity in our efforts to master the science of medicine so that we can relieve human suffering and save lives. It starts in college, when we studied organic chemistry into the wee hours in order to be deemed worthy of being accepted to medical school. The basic science curriculum in medical school would overwhelm mere mortals, but with our noses to the grindstone we study 24/7 in order to move forward and gain entry to clinical rotations. Then we arrive on the wards, privates in a medical hierarchy populated by skilled house staff and storied attendings, the lieutenants, colonels, and generals in an elite, crackerjack army. In order to move up through the ranks, we emulate them in every way: patients come first; medicine comes first; we’re doctors, after all, virtually invulnerable.

I have yet to meet a physician who has failed to buy into this culture of medical exceptionalism. Lesser human beings need not take the Hippocratic Oath and all that it entails.

But, alas, we physicians are human. Sooner or later, each of us hits personal and professional speed bumps: work-life balance challenges that affect us as spouses and parents, stressful changes in the work environment, medical problems, emotional burdens, and the inevitable slow-down that occurs in the fourth quarter of any lengthy career.

Many successful physicians minimize the adversity in their lives and counter it with maladaptive coping strategies. Drink a little more alcohol at the end of a grueling work day and you’ll fall off to sleep more readily. Use that tramadol the patient left in your office to take the edge off of that annoying foot pain and you don’t need to waste half a day getting checked out by some other doctor. Avoid the dark hole of depression that seems to be eating away at you by telling yourself and others that you’re just fine, you’ll get through it. Although they never taught us these nifty tricks in medical school, many of us have mastered the art of self-serving rationalizations. “I’ll tough it out and then I’ll be okay.” It works until it stops working. CRASH!

Over the years, more than 2,500 Massachusetts physicians have found their way to Physician Health Services. It’s not surprising that most of these referrals occur just before things are about to come crashing down.

Individually and collectively, our inclination is to wait until it’s almost too late. A new and important trend at PHS is the growth of self-referrals. More and more Massachusetts physicians are picking up the phone and asking for help when their problems are milder and more manageable. That’s how it should be. We all know that a few ounces of prevention are worth tons of cure. That’s especially true for ­superheroes.

For more information please contact Jessica Vautour, Education and Outreach Director at Physician Health Services, Inc., at (781) 434-7404 or visit www.physicianhealth.org.


Steven Adelman, MD, is director of Physician Health Services in Waltham, Mass. This article originally appeared in the Summer 2015 edition of the Massachusetts Medical Society publication Vital Signs.

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