How Discipline Can Be Transformative

How Discipline Can Be Transformative

September 2020

Some of the people who find board discipline most painful end up feeling grateful for the experience. It takes time, but gradually they find their way from reproof to renewal. We asked them how they do it.

People often show up for the first day of a PBI Education course in a state of shock. Successful professionals who have dedicated their lives to healing others simply cannot fathom how their licensing board or regulator could accuse them of harming a patient. It’s not the specifics of the charge that floors them; it’s the repudiation of their self-image. They have always thought of themselves as selfless heroes. Now they are being told they are villains. At least that’s how it feels.

Their first instinct is to shield themselves from the attack, either by denying they did anything wrong or by blaming someone else — the board, the person who filed the complaint, anyone but themselves. Some never come out from behind their shield. They maintain a defensive posture, dwelling on the board’s unfairness, and launch a counteroffensive, fighting to vindicate themselves. It’s a fight they cannot win, and the longer it goes on, the more isolated and resentful they become. Many never recover the sense of purpose and personal fulfillment that brought them to health care in the first place.

Others eventually let down their defenses and take responsibility for what they have done. But they, too, may get stuck. Overwhelmed by guilt and shame, they feel unworthy of their calling. They start avoiding friends and hunker down in despair. “After my license was suspended, I felt so ashamed I stopped going out in public,” said one physician. “I had panic attacks. And while I didn’t contemplate suicide, I prayed every night that God would take me. And I woke up each morning devastated that even He didn’t think I was worth taking.” However, many clinicians do contemplate or attempt suicide and research shows that physicians die by suicide at a rate that is more than double that of the general population. Other clinicians turn to alcohol, drugs or other self-destructive behaviors.

But for everyone who succumbs to despair or drowns in resentment, there are others who not only survive the ordeal, but are transformed by it. They draw strength from the hardships others simply endure and end their journey in a better place than they started from. As devastating as the experience has been, they look back on it with satisfaction, proud of how much they have grown and accomplished.

“I wouldn’t wish this on my worst enemy,” said one practitioner. “But in a weird way I’m grateful for what happened. I wouldn’t have been able to make the changes I needed to and build a better life for myself if the board hadn’t knocked down my old life.”

We talked to several of these professionals to find out what they learned that might help others just beginning the disciplinary process. Their stories differed, often in dramatic ways. But beneath the superficial differences, the process of recovery and growth was remarkably consistent. 

Asking for help and accepting support is crucial

It’s not easy for people who pride themselves on their self-sufficiency and competence to admit they need help. “Your pride and arrogance trip you up at first,” one practitioner told us. “ You think. ‘I got myself into this mess. I can get myself out of it.’” But there are things others can do for you that you simply cannot do for yourself. Therapists, family, friends, and colleagues can help you look past the shame and guilt of the moment and begin recognizing that you still have value. A physician put it this way:

“People who know you make decisions about you based on your previous behavior and what you’ve shown them day after day. When I told my supervisors and colleagues what I had done, I thought I would be fired. Instead, they thanked me for letting them know and asked how they could help. That made me feel very special. It meant they recognized who I was as a person, and still thought I was valuable, despite the setback.”

There are real risks involved in reaching out to others. It takes trust and courage to share something you would rather keep hidden. And not everyone will respond the way you hope. “Most of the people at work turned away from me,” a surgeon told us. “Someone I had worked with for years and I thought I could trust shut me down completely. We didn’t speak for a long time.” Eventually, the two colleagues revived their friendship, and now, says the surgeon, “the value of our bond outweighs the pain it cost me at first, as steep as that cost was.”  

Several practitioners mentioned a different kind of support they considered just as crucial. It came from people who hadn’t known them before but from people who knew from personal experience what they were going through. Whether it was professionals in a PBI Education remedial course or a support group serving a more diverse clientele, the community of shared experience helped relieve one of the most painful aspects of the disciplinary process, loneliness. 

“You feel like you’re the only one ever to have faced this and like you’re the worst of the worst. It’s incredibly lonely. So when you get together with a group of people facing the same kinds of challenges and you get to hear everyone’s story, you realize that all of these people, despite what they have done, are still good people. They’re still worthy of respect.”

Only you can forgive yourself

No matter how much others support you, in the end, your own opinion is all that matters. If you don’t forgive yourself and see yourself as a worthwhile human being, practitioners told us, you cannot hope to recover from the pain of discipline.  

“One of the hardest things to do is to forgive yourself and keep your head high and say, ‘You know… I did this and it’s going to have repercussions for me for the rest of my life. But even so, I can still strive to be the best person I can be and continue to overcome obstacles. Some people won’t look past your violation. Others will. But even if nobody else recognizes your value, you still have to recognize it in yourself.”

Reaching this point often means letting go of an exalted sense of self-importance, a trait all too common among physicians and other healthcare practitioners. One general practitioner told us he had to admit to himself that he was, like everyone else, a flawed human being. “Hey, you know, I have flaws. I’m not perfect. I’m not the best at everything. And that’s okay. I can still be successful. I can still be worthy of friendships. That’s not an easy thing for physicians like me to accept,” he added, “because we think people love and respect us because of how competent we are. And that’s a problem, because we’re not perfect. We’re very flawed individuals, every single one of us.”

Take control of what you can and let go of the rest

“For the first couple of years, I would spend a lot of time rehashing what had happened and thinking ahead to what might happen in the future. And that’s an extremely anxiety-provoking state to be in, because there are so many terrible things that can happen, so much that is out of your control. And focusing on all that just made me feel powerless, like a victim suffering whatever was thrown at me.”

We heard this same thought repeatedly. And everyone who found a way forward came to the same realization. As one practitioner explained, “With a lot of help from others, I came to recognize that I could either stay in that powerless state and keep trying to control things I had no control over or I could figure out what I could do in this moment to make the best of it.”

Each individual came up with their own solution. One therapist used what he was going through to help him better understand what his patients were experiencing. “It sounds crazy,” he said, “but I’ve been able to use what I’ve been through to become better at my job.”

Another practitioner followed her attorney’s advice, which was to do everything she could to show the board, and reassure herself, that she would not repeat her mistake. “It really helped me feel empowered. I went from feeling powerless to being empowered, and that was huge.”

Whether they focused on becoming a better friend or figuring out how to avoid another violation, each person took control of what they could and let go of the rest.  

Define yourself, don’t be defined by what you did

It took a lot of encouragement from others, and a willingness to forgive themselves, but eventually the practitioners we spoke to found the will to forge an identity independent of what they had done. “One thing my therapist has done for me is remind me over and over that my offense does not define who I am,” one internist told us. . 

It’s equally important to establish an identity independent of your career. Many healthcare professionals have devoted so much of their lives to their profession, they come to believe that they are nothing without it. So when board discipline threatens their ability to continue practicing, it’s not just their livelihood they fear losing. It’s their whole concept of who they are. 

Many people in the throes of discipline are forced to take on roles they never would have considered before. While some find these assignments demeaning, those who find their way through the disciplinary process derive strength from the experience. One example makes the point.

Having lost her house and depleted her savings, an accomplished physician took the only job she could find, handling minor medical issues at a juvenile facility. She went from a posh office with all the latest equipment to a dingy back room with little more than band aids and tongue depressors. As she treated kids for scraped knees and head colds, she learned about other health and mental health problems the students were facing. It was far more challenging than she expected, and far more rewarding. “I really helped some kids and their families. It helped me get my confidence back. If I could succeed in such a different world, I felt I could do anything, and be anything.”

Find gratitude 

At some point, people begin to feel grateful, not for the disciplinary experience exactly, but for what they have gained as a result of it. This gratitude is not something that simply comes to them. They have to work to find it. Rather than focusing on the pain he had endured and the uncertainty he still faced, one practitioner spoke about reorienting himself. “I decided to change my mindset, to focus on being grateful for the support I’d been given and the work I was doing. And that gratitude has certainly been a significant piece of the peace I have found.” 

It takes grit to consciously turn away from what’s frightening and search for things that bring joy. But each moment of gratitude makes the process easier. 

“Despite this looming specter over my life, I try to think about all the positive things that have come out of this. How I’ve been able to work on my marriage and reach a really great place with my spouse, how I’m able to raise my daughter to be a good person. I found that I can truly trust and depend on my friends and my colleagues. And as I’ve drawn on those positive things, it’s been easier and easier to turn away from the negatives and keep growing.” 

It gets easier, but as so many remarked, the struggle never really ends. It still takes strength to resist the waves of anxiety and anger that occasionally wash over you and find gratitude. 

“I still lose sight of that on occasion, so it’s definitely not a ‘Once I was lost and now I’m found’ kind of thing. There certainly are those days when it just sucks,” said one practitioner. “But the quicker I can remind myself what it is I have to be grateful for and focus on what I have control of now, the easier it is to get out of feeling sorry for myself and get back to a place of functioning.”

Slow down

Nothing about this — asking for help, forgiving yourself, controlling what you can, defining yourself, finding gratitude — none of it happens quickly. Asked if he had one word of advice to offer people just entering the disciplinary process, one practitioner said, “It’s a process, so slow down. It didn’t take you one day to get into the mess, and it’s not going to take you one day to get out of it. Coming to grips with things, ultimately facing them head on with help, and then seeing them through, it takes years. But,” he continued, “It gets easier. And I can honestly say, I have never been happier. My life is amazing today, and I’m very grateful for that.”

Note: We have altered identifying details in these stories to protect the individual’s anonymity.