Saving your marriage . . . yourself

It was back while he was building his practice in Vancouver—often specializing in couples therapy for doctor couples—that Dr. Michael Myers wrote Doctors’ Marriages (1988). But he continued to care for couples until 2008. He is the author or co-author of eight books, including Why Physicians Die by Suicide (2017). Dr. Myers’ newest book is Becoming a Doctors’ Doctor: A Memoir (2020) He hasn’t been in private practice since he moved from Vancouver to New York City in 2008. These days he goes back and forth between his apartment in Harlem and his job at SUNY Downstate Health Sciences University in Brooklyn. His work has focused on teaching medical students and residents, serving on the college of medicine admissions committee, acting as ombudsperson for the medical students (investigating mistreatment) and conducting research in physician health. Dr. Myers talked to the Medical Post about doctors’ relationships, his more recent work on physician mental health issues and about the personal reason behind his decision to move to New York. Q: You literally wrote the book on the subject: Doctors’ Marriages. Is there anything unique about physicians’ marriages? We’re probably not that much different than other busy professionals; there are a lot of people who work really hard, and there are issues of how that (impacts) their marriages. But with doctors, many physicians don’t necessarily want to go for help with their marriage when it’s in trouble. However, there seems to be less stigma associated with going for marital help than going for individual help. I’ve looked after many couples over my career who came as a couple, but after a few visits, I ended up seeing one or both of them individually. One maybe realizes it’s not as bad as (they) feared it would be, and also realizes: “Maybe I can talk to this guy? Maybe I can examine some things that were in my life long before I fell in love and got married?” And so couple’s therapy can be the entry into some very good individual psychotherapy. Q: If a couple is having sex very infrequently, is that inherently a bad sign? It’s pretty complex. If their sexual life has become less frequent than it used to be, there’s the question of the quality of their lovemaking. For those couples who feel in trouble and the quality of their lovemaking was already beginning to change or diminish, they may not be that unhappy with the fact that they’re no longer having sex at all because it just feels like it wasn’t pleasant. But I know that at times the busyness of work in medicine can be used as an excuse for not making love as frequently as one once did. And when you drill down on that, it’s really not about the busyness of work; they’re actually avoiding intimacy by working. But most spouses are able to pick that up pretty quickly because they say, “You used to say it was because you’re working so many hours per week, but you’re working fewer hours per week, but now you’re spending more time on your computer.” "That’s when I say, “Have you tried reaching out?” They’ll almost always say: “Of course, I tried reaching out, but I keep getting shot down.” Q: Many doctors marry other doctors: anything unique about doctor-doctor marriages? I’ve seen many dual-doctor couples and they’ll say, “The fact that we’re both doctors, I don’t even think it’s an issue.” And I would agree. They have some empathy though. What you’ll see is if one’s partner is going through a tough time at work or is overworking, the spouse will get it because they know medicine. There’s a flip side to that because one partner might say, “I thought you would understand my hard work and why I’m away so many hours from home because you’re a doctor too.” And without missing a beat the other partner will say, “That is such BS because I know what hard work as a doctor is. But as you can tell, I haven’t made medicine my whole life like you’ve done. And also: You probably noticed how I finish up and I get the hell out of there. I go home because I want to be with you, I want to see the kids, or I want to see my friends or I want to go to the gym.” Q: I know your most recent books have looked at mental health issues for doctors: depression, anxiety, suicide, overfunctioning and burnout. Is it fair to say that a doctor’s partner is going to be impacted first by problems in the mental health area? That’s a very good way of putting it. When I was in private practice, I’d sometimes get cold calls saying, “Look, I’m not calling about myself. I’m calling about my spouse. I am really worried about her and I’ve spoken to her, she won’t go see anyone. Is there any way that you can help us?” I said, “When she comes home from work, you could say, ‘I called Dr. Myers today, he’s a specialist in physician health. I told him how worried I am about you. He’s open to seeing you, but you’re going to have to make the phone call.’” And I would then sometimes get a call like that. That’d be one front. Other times the partner would say, “But we do have some marital problems.” So I’d said, “Well, then why don’t you come together?” And then I’ll start with that. I have an ongoing research project examining family members of doctors who have died by suicide. And in every one of those interviews that I do with those grieving family members, they have just felt absolutely dreadful that their efforts sometimes to get their husband or wife or their mom or dad, who were doctors, to go for help fell on deaf ears. They could see that he or she was changing; they weren’t the same person. And they would plead with them to go for help. But because of stigma, so many different things, they didn’t go. And next thing you know, the person has died by suicide. It’s heartbreaking. The intimate partners of doctors should feel that, first of all, that they would know what to look for. And secondly, that they’ve got a voice, that they can come forward with that. I’ve lectured other doctors and I’ve told them that sometimes the route to care is actually from their spouse. And they’re so shocked that I would even accept a phone call. But why wouldn’t I? From somebody who’s really worried about a loved one who happens to be a physician? Of course I would. Q: What advice do you give to spouses who see their physician partner in trouble? In my most recent book, Becoming a Doctors’ Doctor: A Memoir, I really talk about that because I felt that this is so important for them to have some idea of what they could watch for. They often educate me. They’ll say, “Look, I’m concerned about him because, first of all, he’s working hard. He’s sacrificing. He comes home absolutely used up and immediately heads for the liquor cabinet—sometimes doesn’t even say hello to me and the kids. Once he’s had a drink, then he re-enters family life. The next thing you know, in an hour or two, he’s falling asleep.” But the main things to look for are: not sleeping well, losing weight, being irritable, withdrawing, brooding, seeming down and losing interest in things. That’s when I say, “Have you tried reaching out?” They’ll almost always say, “Of course, I tried reaching out, but I keep getting shot down.” I always say: Put it in terms of how worried you are, so that they know that it’s coming from a good place. If you’re worried that they could possibly harm themselves, then come right out and say it. Don’t beat around the bush. I think for communication, one is better to have gone there—even if we’ve roughly said this thing—than to have not gone there at all. Because in the aftermath of a tragedy, you don’t want regrets. You want to feel that you tried to reach out. Q: What do you say to doctors who feel like they’re struggling but they’re reluctant to seek help because of worry about licence reasons or others’ perception? It wasn’t unusual for me to get a call that would go like this, “Hey, Dr. Myers, my name is Dr. Brown. I’ve been feeling kind of burned out the last, oh, I don’t know, six months or so. I hate my job. There’ve been so many changes, etc.” But then they’ll say, “But I was going to call you, but I kept putting it off thinking maybe I’ll just quit the job, maybe it’ll go away. But my partner is actually worried about something else. My partner thinks I’m slipping into a clinical depression.” And I say I want them to come in. Burnout: the symptoms overlap, there could be a depression going on, which has to be carefully diagnosed and carefully treated. Doctors are funny about that, they seem to be less stigmatized about burnout than they are about depression or alcohol use. So doctors will say, “I am so burned out. My God, I don’t know if I can do this another 20 years.” But very rarely will somebody say, “I thought I was burned out, but I went to this psychiatrist and she’s diagnosed me with depression and she put me on an antidepressant and I feel a hell of a lot better. Plus I’m getting some psychotherapy, I’m looking at stuff from my childhood, and it’s really working.” That latter scenario is unfortunately far too uncommon where they come out like that. Getting people to speak more openly, well, not only does it feel good, but they really help others. I’m always watching for articles in CMAJ or in JAMA or the New England Journal of Medicine or the Medical Post, where a doctor or medical student writes their story. They put it right out there. I always try to contact those individuals and thank them for doing that: that this is a gift to the rest of us in medicine, so that people will know that they’re not alone. Q: Why did you move from Vancouver to New York in 2008? The decision to leave Vancouver and move to New York was both personal and professional. The personal part was that I was coming out as a gay man at the age of 64, which some people say, “God, that’s pretty late!” Coupled with that was the breakup of my marriage. I had been doing sabbaticals here in New York City in quite a few of the previous five to seven years. Then the professional part was, I got offered a job that I just couldn’t resist. It was just right up my alley because I was winding down my private practice, which I had done for 35 years in Vancouver part-time. So I took a full-time academic job here at SUNY- Downstate Health Sciences University. I continued to do clinical supervisory work for about five years until 2013. The sole clinical piece I’m doing in physician health is that I do independent medical evaluations on physicians for the physician health program of the State of New York, akin to the provincial physician health programs in Canada. It’s all worked out terrifically.

Saving your marriage . . . yourself

Register for free access or login.

Related Topics