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A Piece of My Mind
January 29, 2019

Breaking the Silence

Author Affiliations
  • 1Section of Women’s Health, Minneapolis VA Healthcare System, Minneapolis, Minnesota
  • 2Department of Medicine, University of Minnesota, Minneapolis
JAMA. 2019;321(4):345-346. doi:10.1001/jama.2018.22266

I’m sitting in front of a group of 30 internal medicine residents, having agreed to participate in a panel discussion for our residency program. The program directors recently incorporated a wellness curriculum, including content on mindfulness, meditation, and stress reduction. I am a part of an experiential component made up of willing faculty who are here to share their personal journeys with burnout, mental illness, and, in my case, substance use.

I have never spoken publicly outside of the cloistered rooms of recovery about my past struggles with alcohol. Physicians tell patients substance use is a chronic disease, like diabetes or cancer, but my past experiences of sharing my illness with colleagues have not always gone well. Some were supportive and kind, but there were also whispers, rumors, and quickly averted gazes in hallways. Some colleagues subsequently avoided me or have never treated me the same. The hidden message was clear: silence was better.

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    2 Comments for this article
    Refreshing and Revealing
    Louise Andrew, MD JD | www.mdmentor.com
    This is the same state with the same medical board where medical ethicist and Professor Steven Miles related his own experience with depression to medical students who had just lost a classmate to suicide two decades ago. That board then attempted to discipline both Miles and his psychiatrist for refusing to divulge his confidential private records so that they could independently evaluate both for competence (1, 2).  So it is refreshing that this group of educators and trainees were willing to be so candid with one another; and it is to be hoped that none of the faculty who revealed their innermost feelings and failings in MN in an attempt to Break the Silence in 2018 will be pursued by that board as so many others have in so many states, in the name of "patient safety." A doctor a day is too great a sacrifice to a culture of "don't ask, don't tell, and we won't discipline."  


    1. Miles SH. A Challenge to Licensing Boards: The Stigma of Mental Illness. JAMA.;1998;280(10):865. doi:10.1001/jama.280.10.865

    2. Emergency Physician with Depression Chronicles Her 10-Year Fight to Keep Her License - http://bit.ly/SHaneyexperience 
    Help for physicians
    Herbert Rakatansky, MD, FACP, FACG | Clinical Professor of Medicine Emeritus, Warren Alpert Medical School, Brown University
    It is critical for physicians who "break the silence" to have an available, defined path to recovery and health. 47 states have physician health programs (PHP) that provide confidential, effective help for physicians suffering from addiction and/or behavioral illnesses. Many of these programs are affiliated with state medical societies. In some states referral for treatment by the PHP is a legal alternative to reporting to the licensure board. PHP-supervised treatment is effective and is the best option for physicians who wish to continue their medical careers.

    "Breaking the silence" is only the first step to long-term recovery. Like
    other serious illnesses, addiction and behavioral illnesses are best treated by highly qualified professionals.

    An up to date list of all PHP's with contact information may be found at https://www.fsphp.org/state-programs.
    CONFLICT OF INTEREST: Chair, Physician Health Committee of Rhode Island Medical Society (RIMS) (volunteer, no financial relationship)