The Loneliness of Being a Physician

Gregory A. Hood, MD

Disclosures

February 12, 2019

In This Article

Seeking Solutions to End Physician Loneliness

There is, of course, for those of us engaged in continuity of care, the interactions with patients, many of whom are friends who have elected to become patients or patients who become friends over time. While the value of these relationships cannot be overemphasized, it is also true that it is a relationship of uneven sharing.

Even once the medical care aspects of an interaction are concluded, there are appropriate and necessary limits which a physician should not (and must not) overstep with a patient because of the power disparities, differences in privacy standards for a patient/friend, and so forth. Consequently, there's an inherent inhibitory effect on the connective healing of such relationships for physicians, in particular.

This leads some physicians to nonmedical online forums and other online communities. The anonymity of the Internet can free a physician in some unique ways, but of course compels the physician to practice identity concealment. There is no need to assume additional potential medicolegal liability from providing online medical advice. Others online, knowing that "user123" is a physician, will also probably influence how they perceive and treat that person.

As a friend recently said to me, "Doctors need friends who aren't doctors." They also need time to not be doctors during their week. Balancing this set of "imaginary friends" against real-world challenges and obligations can be detrimentally difficult for many.

There were assertions made that the coming of the Internet age and the dawning of robust personal mobile technology would bring us all together, help us communicate, and help us connect. Certainly, at times that is true.

Ultimately, we have learned as a society that the Apple device (or Android, et cetera) on your hip doesn't make you happy. Again, the limitations of our conversational speech in general and in "smart" device communication does not allow us to "see" each other. It is too easy to put up a false face, to hide our feelings, have our posts go unanswered, or to be simply misunderstood.

Even the purveyors of such technology have restricted their own children from using it.[2]

Loneliness Can Be Lethal

The consequences of loneliness and the pitfalls of navigating the complex interplay of relationships, emotions and loneliness are too great to ignore. Loneliness is lethal, according to a 2013 article in The New Republic.[3]

The psychological definition of loneliness hasn't changed much since [20th century therapist Frieda] Fromm-Reichmann laid it out. "Real loneliness," as she called it, is not what the philosopher Søren Kierkegaard characterized as the "shut-upness" and solitariness of the civilized. Nor is "real loneliness" the happy solitude of the productive artist or the passing irritation of being cooped up with the flu while all your friends go off on some adventure. It's not being dissatisfied with your companion of the moment—your friend or lover or even spouse—unless you chronically find yourself in that situation, in which case you may in fact be a lonely person. Fromm-Reichmann even distinguished "real loneliness" from mourning, since the well-adjusted eventually get over that, and from depression, which may be a symptom of loneliness but is rarely the cause. Loneliness, she said—and this will surprise no one—is the want of intimacy.

The modern psychological study of loneliness is often traced back to Frieda Fromm-Reichmann. She estimated that loneliness lay at the heart of nearly all mental illness and that the lonely person was just about the most terrifying spectacle in the world. As the neurobiology of loneliness has been deciphered, her assertions have been confirmed.

Loneliness has been shown to disrupt proper hormonal signals, reregulate the expression of behavioral genes, and further distort the workings of our mortal coils. Last year, loneliness was reported as a potentially bigger health risk than smoking or obesity.[4] Disease associations have been found between loneliness and "Alzheimer's, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people."[3] A key part of feeling lonely is feeling rejected, and that, it turns out, is the most damaging part.[3]

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