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Physicians & Autonomics Anonymous

Dealing with a disabling addiction: A challenge for physician leaders

What would you think if I sang out of tune,

Would you stand up and walk out on me?

Lend me your ears and I'll sing you a song<

And I'll try not to sing out of key.

Somewhere in the near future we look through a one way mirror into a doctor's lounge. Scanning the the room we see a group of anxious individuals sitting in a circle.  They seem uncomfortable being here. Most look downward, trying at all costs to avoid eye contact. The one empty chair is soon filled by an energetic younger man with a clipboard.

"OK, who wants to start?"

No response. 

"Anyone?...No?...OK let's begin with Dr. Dave. Dave, start us off"

"My name is Dave and I'm an autonomic. I haven't demanded autonomy for three weeks now. It's very hard. I still have the urge to interrupt people and help them understand how their thinking process is flawed. I still find it hard to listen to people who are not as smart as I."

"Thanks, Dave. It is hard, but you're doing it. You're doing the hard work and we're proud of you.  Jim?"

"My name is Jim. I haven't demanded autonomy for three months now. The other day, I actually asked a Pharmacist for help!"

Jim is interrupted by applause and shouts of "Right on!, Great job, Jim, You da man!, Dude!"

"My name is Jack. I haven't demanded autonomy for six weeks." Yesterday, I attended a meeting with my team and complemented a nurse who came up with an idea to further reduce wound infections on our surgical floor."

The group again erupts with accolades. "Great work Jack! Way to go! Sweet!"

"My name is Kevin. This has been a very tough week. I came so close to behaving autonomously that I had to call Carl for an intervention....." Kevin begins to sob as others in the group approach and give him a group hug.

OK, not a likely scenario in the near future. But if we define addiction as a compulsive pattern of behavior that is obtained through repetition and persists despite evidence that it is harmful, then is it really a stretch to view our demand for autonomy as an addiction?

When we counsel patients with an addiction to tobacco, alcohol, or drugs, what do we recommend as the first step? We urge the patient to accept the fact that the addiction exists. Isn't it time for us to take that first step and at least recognize that as a profession we are addicted to autonomy? 

I'm not sure the number of steps involved in the Autonomics Anonymous program, but I think I know the first one.

Physician leaders need to confront their own demons with autonomy. Far too often physician leaders, because of their medical training indoctrination, are reluctant to ask for help with the skills they need to be more effective. A good coach or mentor is critical in developing effective leadership skills.

Take it from someone who has wrestled with the autonomy addiction. Ask for help. It is very uncomfortable the first time, but with practice it keeps getting easier. 

Yes I get by with a little help from my friends.

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