Treating Fear and Isolation in America

The 6000-plus physicians and care providers at the American College of Physicians (ACP) 2019 Internal Medicine Annual Meeting were fortunate to have been audience with Vivek H. Murthy, MD, at his keynote speech during the opening ceremony Thursday.

The former US Surgeon General from 2014-2017 gave an impassioned speech to attendees, touching on national and public health issues with a calm, sincere, and confident tone. In as much as someone could in 30 minutes, Murthy felt like was simply one of us. After all, he is.

The Harvard-trained physician was a practicing internist until his appointment by President Obama 5 years ago. His Senate confirmation was a narrow decision, after his comments on gun violence being a public health crisis—following the 2012 massacre shooting at Sandy Hook Elementary School—spurned particular legislators.

In light of more recent events, his public thoughts on the matter seem more innocuous—and as he stated, his point was more to rally a growing opinion among people than it was to create controversy.

On Thursday morning, Murthy neglected some other issues in public health that have headlined the ACP meeting—the opioid epidemic, the high cost of care and medication in the country, insured rates, adolescent nicotine abuse, among others. Instead, he honed in on isolation, its prevalence in our country, and its effect on health. Loneliness is affecting our physician population, he said, and it’s affecting our rates of burnout, depression, and suicide rates.

Let’s suppose I—as a physician—had just accepted a new job with great pay and opportunity to advance my career, but it required I moved to rural Kansas. Almost anyone would congratulate me and praise the decision as a great move. But if I instead announced I’d be moving to rural Kansas to be closer to my family, and would therefore be leaving my current job, most people would believe there is something wrong with me. In our country, our lives are centered on work, and people are idolized when they’ve prioritized wealth and status over family.

Murthy asked, why not do things the other way around? Why not center life around the people you love, then create a job from that? When he first came into the Surgeon General role and spent time trekking the country, he learned the biggest problem facing Americans was fear, and a lack of social connection. Yesterday, he shared the solution: love.

Inside healthcare and out, love creates inclusion. It neglects prejudice, judgment, and bias, and it does away with the symptoms of isolation and fear. No amount of medicine can equal that.

There’s no exact count of Americans feeling isolation and fear for the future, but approximations show it could be at least 30%. Physicians have a critical role in making changes in the health of the country, as well as their own health by promoting family values, and avoiding social isolation. Social isolation is common in the homebound elderly, in teenagers who live within the world of their electronic devices, and by physicians. Everyone is entitled to an opportunity to achieve health, happiness, and freedom.

Surveys consistently rank physicians near the top of the list of trusted professions, and it’s time that we place that trust into a unifying platform—one that speaks up for what is right, even if it may be unpopular, or at times taboo.

I am particularly fearful of dentists. As a result, I've neglected my dental health, as well as personal health for many years. No surprise. Physicians are invincible, not subject to human ailments, right? The unspoken message throughout medical training is, ‘work hard, push through, pick yourself up by the boot straps, stop complaining.’ These are good qualities theoretically, but they don’t work for long. They create physicians who can’t ask for help when they feel ill. They create loneliness and exhaustion caused by doctors secretly carrying around insecurities—especially when we make a mistake, or are confronted with an adversarial situation.

We may ask a colleague for a hallway consult, but may also turn to self-medication with drugs or alcohol. Doctors can get away with drug addiction for long periods of time because no one suspects it, or no one says anything about it.

I was eventually forced to see a dentist by my family. I went to my appointment with fear, resentment, and trepidation. Upfront, I told him how limited and important my time was, and didn’t want to feel any pain. He smiled, put his hand on my shoulder, and said kindly, “Don’t worry, we will take good care of you. You are one of us.”

I didn’t go in to that office feeling that unity. That simple gesture, and acknowledgment of my fear and put me at ease. I realized we shared a commonality in how we care for other people, and his reassuring touch told me he understood. He was also right—he took excellent care of me. Wouldn’t it be nice, to apply that mindset across all of healthcare? “Don’t worry, we will take care of you. You are one of us.”

Murthy pointed out that unless physicians begin to treat each other with kindness, they can’t expect to treat their patients with the compassion they deserve. He told us our opinions matter, and that by expressing them, we can bring along major change in the country. As I talk to doctors I meet around the country, I am struck by how surprised they are when I ask their opinion on social issues. They are great at explaining the work they do, or the study they participate in but are surprised when I ask what they think about the world they live in and practice in, or how they feel. I think many doctors don’t believe that their opinion matters. They see themselves as providing information, medications, procedures. Beyond that, their opinions are irrelevant. Nothing could be further from the truth.

We need to treat each other more kindly as professional. We need to ask for help, and be available to help each other when we notice something wrong. We have the power and the responsibility to try to make our opinions known, which in turn will change the way Americans feel about their country. We have to acknowledge there is too much fear and not enough love in the world. No amount of healthcare reform, medications, or laws will change that.

It’s time to speak out against greed, the high cost of medical care, the corrupt corporate culture that can make billions of dollars, yet balk at paying its workers a livable wage. Care providers are all members of the same club, and we need to practice with mutual respect for each other so that we can come together in a way that will benefit the people we work to save.

I feel so special for the opportunity to know a bit more about Murthy. It gives me great hope that there are better things to come, and that there are those in public service who think like I do, who hope that we will move forward in inclusion, not derision.

Simon Murray, MD, is an internist based in Princeton, NJ. The piece reflects his views, not necessarily those of the publication.Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here.