While spending the day with Dr. Rachel Naomi Remen recently, we had a conversation about how medicine is like a dysfunctional family, something I've addressed here.

Rachel referred me a phenomenal article, Medical Education: A Neglectful And Abusive Family System, which I read with fascination and wanted to review with you here because it’s intimately linked to how we must heal our broken health care system.

We know that abused or traumatized children go on to have a predictable set of characteristics: often, abused boys go on to be abusers, while abused girls go onto marry abusers. But few of you have likely thought about our health care system as a system of ritualized abuse that functions very much like an abusive family dynamic.

Yet, when I read about the ways abusive families perpetuate the violence, my jaw dropped and my heart started hurting. Everyone involved in medicine has been traumatized to some degree, and the defenses we use to protect the “abusive family” not only fail to heal us; they actually produce dramatic harm.

It all starts with medical education, which is where doctors first become traumatized and then, like abused children, they go on to traumatize others. In the medical education system, the family hierarchy breaks down like this:

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  • The “grandparents” are the department chiefs and senior faculty at university programs.
  • The “parents” are the attending physicians, the junior faculty at universities, and science teachers in medical schools.
  • The non-physician faculty are the “in laws,” with the gift of perspective but the stigma of being an outsider.
  • Senior residents are the “older adolescents,” worried about their impending independence as they’re about to fly from the nest.
  • Interns are the “school age children” yearning to be competent but not really having a clue what they’re doing.
  • Medical students are the “babies,” and they’re the most vulnerable to the abuse.

Traits of an abused child/ doctor

First, see if any of these sounds like doctors you’ve met:

  • Limited emotional range
  • Difficulty nurturing
  • Difficulty setting limits around their own self care
  • Either excessively demanding of themselves or others or overly needy
  • Respond to appropriate limits with indignation
  • Vulnerable to victimization because they did not learn they had a right to say no
  • Rigid and constricted, closing themselves off to intimate relationships
  • Suspiciousness of closeness or honesty
  • Isolating
  • In denial about the past abuse

These patterns in abused children and doctors can be healed, but not usually without a whole lot of personal and spiritual growth work.

Unrealistic expectations with inadequate mentoring

Just like our medical school professors, parents in abusive families often have unrealistic expectations of children, who like the scared interns, are left to fend for themselves without proper supervision, then they’re shamed if they express fear or helplessness.

The “parents” figure that since they were left to fend for themselves they shouldn’t have to coddle the next generation. The “children” learn to appear self-sufficient, even when they’re scared or worried about doing something wrong or exhausted from sleep-deprivation or feeling insecure. The “child” perceives their helplessness as a shameful secret they must hide from the “parents.”

Medicine is in denial

Dysfunctional families are perpetuated through generations because the family denies the abuse is even happening. Doctors deny that they were abused and normalize the abuse so they can go on to rationalize abusing other doctors. Just like abused children, they may even forget how badly they were treated during their training.

There is a code of silence in place that stigmatizes a doctor like me, who feels called to point out that the emperor has no clothes. This leads to isolation of those who speak the truth and makes the system at risk of repeating the traumas of the past. Out of loyalty for our “family,” we keep what happens in the hospital to ourselves.

We rarely talk about how bloody scalpels were thrown at us by our “parents” when we made mistakes. We know better than to complain about feeling insecure or inadequately mentored, because it would be disloyal to the “family.” Those who do speak out are viewed as “weak” or “complaining.” The “weak” members of the family are then viewed with scorn and rejected, thus perpetuating the denial and isolation.

Bad-mouthing other doctors is common

Abusive families model poor communication, with parents triangulating children, for example, as senior faculty physicians often criticize doctors in the community, whose patients get transferred to university hospitals when something goes wrong. The med students, interns, and residents witness the faculty badmouthing other doctors, confusing them. Who can they trust? It only furthers the isolation and lead the “children” to grow up thinking it’s not safe to make mistakes or reach out for help when something goes wrong because you will be publicly shamed. Mistakes are therefore hidden. Nobody apologizes if they do something wrong.

As doctors, we’ve witnessed other doctors get slaughtered by those within our profession during Morbidity & Mortality conferences, when doctors review bad outcomes and wind up pointing figures of blame at those deemed to have made mistakes. There’s no room for humanity and no support from your peers if there’s an inevitable bad outcome, something every doctor will face many times in their careers. This pattern fosters low self esteem, and the “children” wind up either becoming perfectionists or giving up altogether.

Because doctors feel they can’t ask for help, they learn rigidity. There’s no room for questioning or curiosity about the kinds of self-healing concepts I talk about in my book Mind Over Medicine. Many still traumatized doctors have to make me wrong or dismiss me as “alternative” because there’s no room in a dysfunctional family for new ways of viewing even that which is scientifically proven truth.

So how can we heal doctors?

I’m on a mission to heal our broken health care system, but even calling it “broken” makes me threatening to the system. As abused “child” myself, I’m supposed to keep quiet about it. Yet, more and more doctors are speaking out about the abuse. That’s why one of the pillars in my Whole Health Medicine Institute Physician Training Program is healing the healer. Until we heal from the traumas our education inflicted upon us, we will go on to perpetuate the trauma, not only to other doctors, but to patients, nurses, alternative medicine practitioners, and other hospital staff.

How can we change this?

1. Address the denial and speak truth.

When I gather doctors together, I give them the opportunity to break the code of silence about the trauma. Once you get them started, the flood gates open and you can’t keep them quiet. The trauma is intense.

2. Reparent ourselves.

Because we were not adequately “parented” during our training and were often traumatized by the patriarchy, we have to learn to “mother” ourselves, giving ourselves permission to indulge in radical self care.

3. Permit mistakes.

In order to let down some of the armor most doctors wear, we have to make it safe for them to be imperfect. As long as they’re worried about being shamed not only doctors, but by vicious malpractice attorneys and angry patients, they’re going to keep their hearts under lock and key.

4. Encourage dialogue.

Doctors need to be able to speak to each other, but they also need to be able to hear from others how the consequences of their trauma affect patients, other doctors, and other health care providers. I’ve been functioning as the “family therapist” in the community conversations I’ve been facilitating around the country, but you don’t need me to have these conversation. Anyone with experience creating sacred space and facilitating neutral dialogue can make this happen.

5. Invite compassion and allow reconciliation.

Conversations between the abused and the abusers need to be facilitated, as I’ve been doing on my book tour for Mind Over Medicine. Once the abused “child” realizes the “parent” was also abused, there’s room for compassion, and once compassion is touched, there’s the possibility of forgiveness and breaking the cycle of abuse. As conversation opens up not just between doctors, but between patients and other health care providers, medicine will start to heal.

Some good news: change IS possible

This model of healing was demonstrated in post-apartheid South Africa with the Truth & Reconciliation counsels. It has also been modeled by the Crime Victim’s Rights Act, which gives victims of violent crimes, like rape and murder, a chance to speak to the perpetrator in court and have the opportunity for restitution. Not only are doctors traumatizing each other; those who have not healed from the trauma are traumatizing every other cog in the health care wheel.

To heal health care, we must first heal doctors, which is what I’m trying to do with my MD training program and the HealHealthCareNow.com forum we will be activating in 2014. (Sign up now to be the first to be part of the revolution.) I wrote some other ideas about my vision to health care, which you can read about here, but I think this is where we must start.

I’d love to hear your thoughts. How DO we heal health care when the system is so traumatized?

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