Connecting the Pieces
Born in Los Angeles, Monica Faria’s Guatemalan family spoke no English. The multicultural childhood laid the foundation for her career in psychiatry, making the young Dr. Faria sensitive to what others were saying and feeling. Despite being drawn to sciences, animals, and nature in high school, she did not have the self-confidence to see medicine as a path forward. That changed in college.
While attending Northern Arizona University (NAU), an advisor helped her to connect the pieces, pointing out that medical school was within reach. Dr. Faria was studying the burgeoning field of neuroscience, which merged her favorite studies of psychology and biology. When she started hearing about Freud’s theories for emotion predicated upon molecules and neurotransmitters, she was hooked. Dr. Faria recalls in influence of books such as Molecules of Emotion by Candice Pert, which presented the body and the mind as a fluid system.
Residency to the Brink
After surviving the University of Arizona College of Medicine, Dr. Faria accepted a general surgery residency because the specialty symbolized strength and courage and was a way for Dr. Faria to deliver immediate results to her patients. But the second year of residency pushed her to the brink. Overburdened by long hours and constant paging, working thousands of miles away from home, and being among few Latinas doctors brought little to no satisfaction. After two years of anguish, Dr. Faria left what she and others viewed was a malignant residency program on the East Coast. She had never felt that level of desperation before and began to see a psychiatrist for support.
“What remains in diseases after the crisis is apt to produce relapses.”― Hippocrates, Aphorisms
Looking back, Dr. Faria sees a young woman who was extremely depressed, at times suicidal, and who was not given the resources or time to get things figured out. After checking herself into a hospital for treatment, her doctor said physicians had to ‘live with depression.’ So, Dr. Faria followed the treatment team’s recommendations for medications and an extensive outpatient program with group therapy. Over the next few weeks it helped her recover and see a way forward.
At her family’s urging, Dr. Faria returned to Arizona. Without a license to practice, she worked at a law office and got a crash course in organization, legal writing, and health care law. A year later, when she applied for a medical license, Dr. Faria was no longer seeing a psychiatrist or using medication. One question asked if she had suffered from a medical condition that could impair her ability to practice. Feeling like she was in a stable situation, Dr. Faria didn’t feel it necessary to reveal that she had checked into a hospital for treatment. After an eight-month wait, the Arizona Medical Board requested her entire medical history, stating they were not convinced her condition had been resolved and were not ready to grant her licensure. Later they denied her application, citing unprofessional conduct for omitting the details of her mental health treatment.
The Board gave her the opportunity to reapply if she would follow certain requirements, including undergoing a comprehensive mental health and substance abuse evaluation. Under a significant amount of anxiety, Dr. Faria’s new psychiatrist put her back on medication and advised she undergo said evaluation at Talbott Recovery in Georgia, founded by renowned cardiologist Dr. G. Douglas Talbott who had been in recovery himself and was a formative figure in the AMA’s Impaired Physicians Program.
At Talbott, Dr. Faria met with multi-disciplinary teams who provided a 360-degree assessment. They confirmed her history of depression and other co-morbid conditions were stabilized. Also, they concluded she had only intermittingly abused substances in the past but that she did not have a substance disorder. Unfortunately, the Arizona Medical Board rejected Talbott’s evaluation findings and requested she attend a place of their choosing. Staff at The Meadows of Wickenburg provided a similar assessment. They also identified a history of depression, eating disorder, and substance abuse yet they found no current impairment. That assessment, and in conjunction with the approval from two consultants to the Arizona Medical Board, allowed her to finally get licensed to practice medicine in Arizona.
“A journey into the unknown territory of the mind is fraught with confusion and anxiety. I cannot afford delaying embarking on a quintessential mission to discover a reason to endure the heartache and tragedy that inevitably comes with living an all too human existence.” – Kilroy J. Oldster, Dead Toad Scrolls
Through the difficult journey, Dr. Faria found several allies, including the two consultants who would later become mentors during her fellowship and even business partners later in her career. Newly licensed in Arizona, Dr. Faria worked in an urgent care setting. Enjoying one-on-one interactions with patients confirmed psychiatry would be a better fit for a specialty. Nearly three years after she first applied for licensure she had learned what she needed to do to stay healthy and found herself in the right place in life to shift specialties.
The Whole System
Since becoming a psychiatrist, Dr. Faria has wanted to overcome the stigma associated with mental illness. Seeking care is often seen as a weakness, not on par with maintaining physical health. Dr. Faria says we can change that perspective, “Through education, support, and by having payer systems that understand the need for more time with patients.”
Besides, mental health, physical health, and spiritual health are interrelated. Dr. Faria is pleased to see more research showing links between the nervous system and immune system. Although emotions are physiological changes that directly impact how we behave and view the world, Western medicine remains focused on treating disease, not preventing it. Dr. Faria sees this evolving. She says, “Psychiatrists are collaborating with their medical peers to treat patients in an integrative way through medical home models and improved electronic medical records to allow interdisciplinary communication.” For her patients, Dr. Faria consults with fellow physicians to provide a more holistic diagnosis and treatment plan.
Caring for Colleagues
Most of her patients are adult health professionals who are symptomatic from an addiction or mental illness. Often, with chemical addictions to alcohol or opioids or behavioral addictions like gambling, pornography, or hoarding, some patients have co-occurring conditions. Dr. Faria identifies what patients need, helps them to get through the initial period of peeling away what has been pathological, and then guides them to find a healthier outlook. The process can take years, because a big challenge is motivating patients to see a new path forward. Addiction treatment may also involve educating family or involving them in the recovery process whenever issues at home led to the addictions.
Dr. Faria views medical societies as playing a pivotal role in physician wellness. She says, “It’s about connection, mentorship, and the idea that you can do more in numbers through synergistic collaboration than alone.” As President of the Arizona Chapter of the Society of Addiction Medicine, she saw how professional and personal bonds provide physicians with a stronger coping network to lean on whenever they face what may seem to be insurmountable stress.
Everyone, including physicians, need mental health hygiene, including outside support. Dr. Faria says, “We need to have people seek outside help to understand where they’re at, decide if they want to change, and then link them with someone who can help over the long term.” She continues, “This is more than reacting only when patients are in extreme distress before helping them. We are still somewhat away from that happening.”
Advocating for Better Physician Mental Care
Most doctors are slow to admit they have an issue because they are afraid of the impact it will have on their career. Unfortunately, that can be true. Physicians don’t have the same privacy protections as their patients, which can lead to investigations, potential loss of liability coverage, and loss of employment.
Although every state medical board has a different physician health program with different structures and/or requirements, Dr. Faria sees improvements happening locally and elsewhere. Questions on licensure applications focus more on present conditions and less on the past. This leads to fewer inquiries into a physician’s medical history. Also, more consultants and treatment centers have been added to the resources the Arizona physician health program relies upon. This allows for improved access to evaluations and/or treatment, which can speed up the process of license reinstatement for many.
Still, Dr. Faria would like to advocate for a safe-haven for physicians to seek help without repercussions on their medical license. She also advocates for consistencies across the various state physician health programs. For example, Dr. Faria argues there should be a national standard on the type of specialist who treats the complex needs of physicians.
Another topic to tackle is the Arizona requirement for physicians to report a peer who is impaired or suspected of being impaired. “Even though that rule is in place for the greater good, it has stopped physicians from speaking to one another,” says Dr. Faria. “It has stopped physicians from being one another’s best medical and behavioral resources for the fear that engagement may get them reported.”
The Arizona Medical Board and the Arizona Board of Osteopathic Examiners are aware of these challenges. Now more than ever, they are receptive to ideas on how to help improve the system. Cases before the boards are being reviewed by more physician consultants, which leads to faster resolution. The boards are also allowing for assessments of monitoring to be done sooner and chances for review are being given more consideration.
Advice for Physicians
“You’re not alone and it’s never too late to get better.”
Dr. Monica Faria believes the most important thing for her fellow physicians to know is that “you’re not alone and it’s never too late to get better.”
Addictions and some mental health disorders can distort our view of what’s possible, because of changes in the brain. When someone is dealing with advanced addiction or other mental health condition, the part of our brain designed for complex decision making and creative solutions does not work property. It’s important to break the cycle by seeking help.