Physician as Wounded Healer – Dr. Donald Friedman, MD

The concept of the physician as a wounded healer and how it can positively affect the practice of medicine has been around for a long time.  In Greek mythology. Chiron was the first wounded healer.  He was accidentally wounded by an arrow from Heracles’s bow.  He didn’t die, but suffered terrible pain for the rest of his life, as the wound never totally healed.

Donald M. Friedman, MD

Donald M. Friedman, MD

Chiron searched for his own cure and in the process learned about suffering and healing.  He taught others, particularly Esculapius, one of the founding fathers of Western medicine, about the healing arts and through his teaching found comfort from his pain.  It was because of his deep wound that Chiron became known as a great healer in ancient Greece.  Well known historical figures have commented on this image of the wounded healer over the years.  Plato said that the most skillful physicians rather than being models of good health are those who have suffered from all sorts of illnesses.  Thomas Jefferson asked, “Who then can so softly bind up the wound of another as he who has felt the same wound himself?”  Carl Jung, the famous psychotherapist, said “The doctor is effective only when he himself is affected.  Only the wounded physician heals.”  Jung also believed that a malady of the soul was the best possible form of training for a healer.

So what are the wounds that can affect the wounded healer, and how can they contribute to the healing process?  First of all, everyone is woundeed in some way, and that includes physicians.  There may be past physical or emotional traumas, illnesses that are physical or mental or both, difficult events or situations, losses of significant relationships, burdens, betrayals of trust, addictions, obstacles to overcome.  Any of these wounds can be a source of great knowledge and wisdom to the person suffering them.  They may also be a springboard from which that person can move on to new levels of insight and a more meaningful and vibrant life.  Our wounds can teach us about ourselves and can also help us heal ourselves throught self-acceptance and compassion.

In the case of the wounded physician who is self-aware, that physician better understands what the patient may be experiencing and can be capable of showing the patient compassion and acceptance.  In this way the physician-healer conveys empathy to the patient instead of sympathy and can encourage that patient through this support to find the inner strength and resources the patient may have for his/her own healing.  A great connection can occur between the physician and patient that is healing in itself and exists on a spiritual as well as medical level.  In this interaction, great transformation can occur for both the patient and physician.  They can learn form each other both about the healing process and also about new ways of being and seeing.  Patients and physicians can teach each other about how to deal with and find meaning in suffering.  But, the physician, aware of and accepting of his/her own wounding, life experiences, and insights, has to start the process off by showing the patient the understanding that is so supportive.  Medicine thus becomes more than giving pills and doing procedures.  It is the encouraging of a patient to emerge to a new level of awareness that helps that patient deal with a diseaase more effectively.  It is all based on a shared humanity related to a common ground where particulars may differ, but themes are universal.

This process totally depends on the physician’s own awareness of his/her own past woundings and present emotional issues.  In fact, those wounds may have even determined why the physician went into medicine in the first place.  It involves digging deep to understand oneself and one’s motivations, behavior, and reactions.  If the wounds and past experiences remain below the surface and are not accessed by the physician to a conscious level, the physician’s potential knowledge, wisdom, compassion, and understanding are not available for the patient’s benefit.  As so beautifully stated by Serge Daneault, M.D. PhD. in his paper The Wounded Healer (Canadian Family Physician, Vol 54, Sept. 2008), “There is no reason for physicians to be ashamed of their suffering.”  Viktor Frankl, the psychiatrist who survived concentration camps during the Holocaust, also states in his book Man’s Search for Meaning that suffering is an essential part of the human experience and therefore has meaning in one’s life.  Accepting this fact and accepting one’s suffering gives meaning to one’s life.  To acknowledge one’s wounds means one has to acknowledge one’s vulnerability, and this may be a difficult process for many physicians, particularly if they are put on a pedestal by their patients and expected to be perfect in how they interact with and help patients.  But accepting, and even better, embracing one’s vulnerability opens the door to better communication, understanding, and support of patients.

In my own experience, I had to deal with my perfectionism in the office.  I was terrified of making a mistake with a patient.  This is not an uncommon problem with physicians who are usually highly motivated and driven to do the best they can for patients without failure.  It took years for me to realize that no matter how hard I tried, I was going to make mistakes.  Once I faced this fact and accepted it as a reality, I learned self-acceptance and self-compassion.  I still tried my best, but wasn’t under such pressure and was more open to examining and learning from the mistakes I did make.  And to my great surprise and astonishment, I became a better doctor when I wasn’t so preoccupied with not making errors.  I was so much more present for patients, and I was able to listen more intently and hear what they were telling me.  Interacting with patients became such a more enriching experience, and I became more aware of what patients could teach me and what I in turn could give to them by my knowledge and experience.  So, confronting my wound of always having to be perfect enabled me to be less judgmental of patients and more effective in encouraging them to be more loving and accepting of themselves, no matter what the illness or problems were.

Besides the past wounds, physicians also have to deal with the wounds the current medical system inflicts on them.  As Dr. Daneault points out in the article mentioned above, physicians are overworked and exhausted in the current medical climate.  There is frequently a sense of guilt when the physician wonders if everything that could have been done for the patient was done, especially in an atmosphere of frustration where it is harder to get things done, and there is less time to spend with patients.  And that feeling of not always having enough time to deal with some very complex medical and emotional patient problems and issues can lead to suffering on the part of the physicians.  Frequently, instead of considering the “whole patient”, the physician relies totally on technology instead.  This can be so less satisfying as well as contradictory to the original goals and aspirations of the physician.  Such a situation makes it harder to find meaning in the work a physician does.

In that light, Robert Klitzman, M.D. did some interesting and meaningful research that resulted in his book When Doctors Become Patients. He interviewed doctors who had illnesses, many of them serious and life threatening;  many had recurrent hospitalizations.  While it may be difficult for many doctors to see themsedlves as patients who may get sick, if that does happen, there can be profound moments of insight, deepening awareness, and the development of transforming empathy for their own patients.  For many physicians in this book, it changed the way they treated their own patients.  The suffering of these physicians led to more compassion for and connection with their patients that was returned to them as well.  The vignettes and interviews in this book demonstrate how illness can be transforming, if the doctors were willing to be reflective and contemplate their own vulnerabilities.

Some of the medical practice issues these doctors became aware of and focused on as a result of their own illnesses were: communicating better and providing more time and attention to patients for meaningful interactions;  they actually listened to their patients better.  They also offered more information to patients and were more willing to share their uncertainties about diagnosis and treatment as well as what their clinical reasoning was and how they were approaching the medical problem.  Many became more available and accessible  to patients and were more aware of a patient’s sense of helplessness and dependency, should it be present.  Many of the physicians who had been or still were ill became more aware of the importance medical tests were to patients and how traumatic and anxiety-provoking they could be.  As a consequence of this awareness the physicians provided the results to the patients more quickly and took time to explain what the test results meant.  Ill physicians were also better able to diagnose symptoms that may be vague or difficult to quantitate.  These doctors were thus more sensitive to subtle symptoms they themselves may have had.  The physicians were also less judgmental of their patients and understood problems of compliance with the medical regimen, especially if the doctors had experienced medication side effects or found it difficult to stick to a rigorous medication schedule.  One physician said he had a better understanding of what patients were going through with these issues because he went through them himself.

Dr. Klitzman also pointed out that many physicians who had been or were ill became more aware of “Nonmedical aspects of care” such as whether the patient could afford medications, had transportation to the office, and had adequate help at home.  The physicians were also more likely to stress that patients have life goals they could work toward.  These doctors were also more conscious of protecting the patient’s privacy and confidentiality.  Ill physicians were more willing and able to talk about difficult subjects such as sex, sexuality, relationships, and unhealthy behaviors.  And finally, these physicians were more honest and sensitive in how they communicated bad news and difficult medical outcomes, especially concerning death and dying issues.  There was much more empathy because, as Dr. Klitzman points out, “Confronting one’s own mortality can make it easier to confront that of others.”  These doctors would be much less likely to say to a patient there is nothing more that could be done as opposed to saying they would make all efforts to make the patient comfortable and be there for the patient to address whatever needs might arise.

So, to summarize, what are the positive effects that being a wounded healer can have on a physician and, as a result, on the patient and the future of medicine?  Dr. Daneault feels that physicians acknowledging their own personal wounds and suffering can lead to a great creative force in medicine.  There would be more significant connection with patients, better use of constricted time because of more heightened sensitivity, more chances for patient healing on all levels, and greater physician satisfaction through finding more meaning in medical work.  The beauty and hope of all this is that the physician and patient can help each other along on their journeys to wholeness.

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