Physician Heal Thyself
Should physicians be their own patients?
“Physician, heal thyself.”
-Luke 4:23
As with any quote, it is important to consider it in context.
And he said to them, "Doubtless you will quote to me this proverb, ‘"Physician, heal yourself." What we have heard you did at Capernaum, do here in your hometown as well.’”
Luke 4:23, ESV
In this verse, Jesus is speaking to critics in his hometown. He predicts they will soon be asking him for justification or proof of being the Messiah.
“Physician, heal thyself” is often used in the context of reminding someone not to act hypocritically. I would like to consider the idea more literally as it relates to the health of physicians. Should physicians be responsible for healing themselves? Are they hypocrites if they do not or cannot?
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There is an interesting dichotomy that physicians experience when it comes to their personal health care. On the one hand, there is some expectation physicians are healthy as they have a knowledge of how health works and presumably apply it to their own health.
One author gives the example of treatment advice from a dermatologist whose face is covered with a raging rash may not be taken with much authority, since clearly he cannot heal himself.
However, this assumes physicians are treating and should treat themselves.
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Should physicians be their own doctors?
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In allopathic medicine, treating oneself is often either discouraged or not allowed. The American Medical Association’s (AMA’s) Code of Ethics’ decrees “Physicians generally should not treat themselves or members of their immediate families.” It goes on to comment treating oneself or family members clouds professional objectivity and negatively influences the ability to make sound medical judgements. Exceptions to this general rule may include medical emergencies, minor problems, short-term care, or offering care in isolated settings where another physician is not accessible.
This cultural requirement of needing to be seen as healthy by patients and the recommendation against self-treatment sets the stage for the dichotomy that is the healthcare of physicians themselves. We’ve often heard of doctors being the “worst patients,” - not particularly surprising in light of these conflicting expectations.
Patients expect physicians to be well, placing pressure on physicians to achieve and/or maintain health. This objective may become so engrained it prevents physicians from showing up ourselves as patients in another doctor’s office. We do not want to be seen as ill or failing to achieve health, regardless of the setting.
At the same time, physicians are discouraged from treating themselves as we saw in the AMA’s Code of Ethics. Together, these factors conspire to make it difficult to fulfill the demands of “Physician, heal thyself” - whether the healing comes solely from oneself or through treatment by another physician.
What is an ill doctor to do?
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We Can Learn from Other Healing Traditions
Some healing traditions leverage, and sometimes even encourage, the concept of learning through healing oneself. Traditions such as ayurvedic medicine, shamanism and traditional Chinese medicine may make use of this concept in their trainees. “To study ayurveda is to study oneself” as the Ayurvedic Institute notes.
A notable distinction between allopathic medicine and other healing traditions is the use of pharmaceuticals. Clearly, in some cases it is inappropriate or even illegal to self-prescribe controlled substances. However, other prescription medications present a gray zone of technically allowable self-prescribing; however, this tends to be discouraged from an ethical perspective. Additionally, prescription medications have a potential for harm in most cases if used inappropriately.
Outside of the use of prescription medications, however, there are many other avenues to self-healing of the physician (such as those emphasized in other healing traditions) that may be pursued with little controversy. Lifestyle changes such as optimizing sleep, nutrition, and movement; addressing emotional and spiritual health; and the appropriate use of nutraceuticals all present ways in which a physician may approach self-healing in a largely uncontroversial way.
The use of lifestyle changes and non-pharmaceutical approaches to healing is a vital distinction and one allopathic training should embrace and encourage more structurally as a part of medical education. Healthier doctors appear to offer better health counseling advice to patients. The largest roadblock to this is, of course, the lack of education on these topics in medical training.
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On Healing and Moral Injury
I would be remiss to write on this topic without noting the epidemic of moral injury (sometimes referred to as “burnout” among physicians). While this could be a blog - or many blogs - on its own, options such as direct primary or specialty care and physician unions hold promise for helping physicians heal wounds inflicted by the broken healthcare system. Sometimes “Physician, heal thyself” means walking away from a job that does not serve well-being and walking towards or creating one that does.
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On Healing Thyself as a Form of Learning
Recently, I decided to apply this idea of “heal thyself” to a health issue I was struggling with myself. As a patient, I had found the medical system as impersonal as it had felt practicing within it. The experience reminded me once again why I decided to open my own direct primary care practice after residency to practice my values of relational, compassionate, and holistic care. Out of necessity and on the encouragement of a friend, I realized I could apply my own knowledge and experience to help heal myself. And it worked. But it took me a couple of years before I learned this lesson - that putting our knowledge to use for our own healing is not wrong.
Through that curriculum of self-study and healing, I learned. I learned about the human condition, the power of integrative medicine, and a holistic approach to building health. I learned more in-depth pathophysiology, anatomy, and compassion. I learned a lot. I now use that knowledge (and newfound health) to help others heal.
Learning by healing ourselves can be a powerful tool to grow as physicians and enjoy greater health as we care for others.
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Limitations of Self-Healing
In addition to the noted limitation of self-prescribing, there is also the limitations of personal insight and humility.
As the old joke goes, “What is the difference between doctors and God?”
“God knows he’s not a doctor.”
As much as we may struggle to admit it at times, we as physicians sometimes lack insight into our own health concerns. This is part of our human condition. Having an outside perspective can be helpful given our lack of personal omniscience. As members of the human race (aka, “not God”), it is good for us to be reminded of this and occasionally humbled to seek help. And being a patient from time to time may help us be better doctors.
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Bringing It All Together
Going back to the original passage, it’s important to note that Jesus is describing (rather than prescribing) a common proverb at the time. As a profession, we can do better at encouraging and promoting the health of physicians through medical education, cultural and systemic change. We can (and should) be our own patients with safe limitations, such as focusing on improving our health through non-pharmaceutical means.
At the same time, illness reminds us that we are not God, and we have human limitations. When we do choose to seek support, it may not only help us heal, but be better physicians. So while we should be our own patients, physicians that are unwell or those that choose to seek support should not be shamed as hypocrites. It would be far better to support the physician in their healing by reminding them of their own knowledge, self-efficacy and creating a culture that encourages physician well-being.
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“Physician, heal thyself.”
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This is part of a collaborative series with Hans Duvefelt, MD of A Country Doctor Writes. You can read his great blog entry on this topic here.