In the Aftermath of a Violation – A Two Part Journey
As health care professionals, we know the advantages of preventive care. So it’s only natural that we try to help professionals avoid boundary violations before they get in trouble. Sadly, the medical profession has done a poor job of teaching providers how to maintain their professional health, but those of us who see the painful results—for providers and patients alike—are committed to doing all we can to prevent future problems.
Just as we know that a patient is more likely to exercise and maintain a healthy weight if he understands the potentially devastating effects of hypertension, we believe that one of the best ways to help professionals stay professional is to help them understand just how catastrophic a boundary violation can be to their professional and personal lives.
And once someone is already in trouble, it’s every bit as important to help them persevere, learn from their mistakes, and find their way back to a rewarding life. Patients need to believe that their treatment will eventually make them better; in the same way, professionals who have been disciplined need to know that the often painful process of recovery can lead them to a better life. They need hope.
So in this two-part article we take a look first at the sequela of professional violation: the devastating cascade of misery that often follows in the wake of a board action. Then for those who are already suffering and in danger of losing hope, we offer a first-person account of how one professional found her way back to a happy and productive life.
We see people suffering the tsunami of violation every day, and we see them emerge from the struggle just as often, generally stronger and more at peace. The key is not to fight against what is happening but to learn from the experience, to understand both how it all happened and why. Only then can someone turn the tsunami of violation into a two-part journey that begins in pain but ends in a happier, more secure life.
Here, then, are two parts of the journey.
Part One – The TSUNAMI of VIOLATION
People who have lived through a tsunami describe what at first seems a small, unremarkable line of water approaching, like an unusually high tide. But the wall of water doesn’t stop; it keeps coming, relentlessly uprooting everything that once seemed permanent and secure.
The seemingly unending impacts that follow in the wake of a professional violation are like that.
The violation itself is often momentary—an uninvited hug, a misunderstood comment, a lapse in judgment. When a complaint is made, and the board opens an investigation, it can seem like a ludicrous over reaction. If you’re the one being investigated, you may, like many, think it will all blow over or end up with a simple fine, like a parking ticket. For months, your life may go on as it always has, even as the case is passed to a probable-cause committee and then onto the licensing board.
But then the board announces its decision. It is not a parking ticket. Your license has been suspended or revoked; or perhaps you’re been put on probation and told to enroll in remedial classes. You’re in shock. This “How can this be happening? It was a momentary mistake in a long, unblemished career. It doesn’t make any sense.
Before you have a chance to regain your footing, the tsunami surges on, sweeping away the life you have known. Even a light disciplinary action—a six-month probation, say—can trigger almost immediate action by the rest of the medical credentialing community.
Once the board posts its decision on the National Practitioners Databank (where it will live forever), your hospital credentials are pulled, your board certification revoked, your insurance protection withdrawn. The career you have worked so hard to build up, now lies in rubble at your feet.
Anger is likely to be your first response. The board is just wrong, unjust. You will fight back, appeal, make this right. But sooner or later you learn that your outrage and resistance only make things worse. Eventually you have to face the fact that no amount of fighting is going to change the board’s decision. You have to accept the reality of what has happened.
And then it hits you: you are no longer the respected professional you have always known yourself to be. Colleagues, partners, patients, neighbors—nearly everyone you thought of as part of your life now shun you, as if you’re shame is contagious. If you’re lucky, those who are closest, family and friends, stick with you, but you can see how they, too, are suffering as a result.
You feel humiliated, ashamed, afraid to go out and risk the scorn of others who have heard about what’s happened. And as the local media jumps on the story, the circle of those who have heard about your case grows exponentially. The mere possibility of meeting people at the mall brings on a panic attack. You start shopping in the middle of the night.
If you’re like many professionals, you have come to define yourself by what you do, to equate your value as a human being with the respect and admiration your career has brought you. Now all that is gone. Nothing feels secure anymore, not even your identity. Even if criminal charges are not filed, and you avoid jail, you will likely face legal fees and possibly civil penalties. Your marriage may founder.
At this point, all the rage you had been directing outward—at the board, at the person who brought the complaint—turns inward.
Months of deep depression are common at this stage, leading many to think about suicide. A small number, no one knows how many, actually take their own lives. In a 2015 article about physician suicide, The Daily Beast (March 23, 2015) told the story of of Dr. Gregory Miday, a young hospital physician with addiction problems, who reported himself to his Physicians Health Program in 2011. He had recently been awarded a respected oncology fellowship, but now, fearing that he would lose his license and his career, Miday drew a bath, lit candles, surrounded himself with family photos and used his surgical skills to end his life. Afterwards his mother, a psychiatrist, said, “When you threaten doctors with the loss of everything they’ve worked so hard for, what do you think it’s going to do? It’s going to make them feel like they have no way out.”
Miday’s incident is an extreme case. The vast majority of violators find the strength to seek help and move forward. For those who hang on, the crucial next step can seem the most degrading. With no source of income and bills piling up, once lavish lifestyles have to be abandoned. No longer able to do what they have always done, many are compelled to take whatever work they can find, however distasteful. A surgeon ends up selling cars; a psychiatrist waits tables; a lawyer answers phones.
Paradoxically, it’s at this low point that people often begin to rally. Forced to try something other than the career that has always defined them, they can begin to take stock of who they are and what they have to offer. Having lost so much of what they thought was essential, they find a new freedom to rethink priorities and reinvent themselves. Almost always, those that reach this point, begin a journey of recovery that brings them back not to where they were, but to someplace better, leaving them more balanced, more secure, and say many, happier than they were before the tsunami struck.
Part 2: The Way Back
Each person’s journey back is unique. What is common to almost all is a willingness to take responsibility for their actions and to understand the pain and suffering they’ve caused their victim. They also find the strength to probe their own vulnerabilities, look afresh at what they have to offer, and to realize that they are not alone. Easy enough to say. But as the following firsthand account demonstrates, doing it is far more difficult and far more rewarding than most people realize.
This is the first in a series of personal stories that demonstrate how those who violate professional boundaries find their way back to a better life. (Additional stories will appear in future issues.) In this case, the professional is not a member of the health care community. She is a graduate of PBI, which has expanded over the years to help professionals in a number of fields, including the law, the judiciary and education. The experiences of violators in all these arenas are striking similar, as are their journeys back.