How the Closed-Door Practices of Medical Regulators Contribute to Physician Suicide
I’ll never forget the day that I received the letter from my professional regulator, the College of Physicians and Surgeons of Ontario, informing me that I was under investigation for the abuse of a patient. My heart started pounding in fear the moment I saw the envelope with their logo on it, even before I knew what it contained. Like all physicians, I had already learned to fear my regulator — we know that nothing good can come from their interest in you. I tore it open with shaking hands, dreading what I was about to read.
That was the start of a protracted and traumatizing process that spanned almost three and half years. Ultimately, it culminated in their decision to revoke my medical license and end my career. The outcome was nearly worse; it came very close to ending my life.
If you’ve read my other posts on Medium, you’ll know more about the events that led to my receiving that envelope from The College. You’ll know that my story had started long before I received their letter, and that the patient who they accused me of abusing is a serial predator of women who had extorted, raped, and terrorized me for over a year. You’ll also know that he contacted my regulator and told them that we had an “affair” in order to punish me for breaking away from his abuse and also for protecting a young woman patient from him. He had promised to destroy me if I ever dared to stand up to him, and The College’s letter was very much one of his attacks. My abuser had bragged about manipulating people like pawns in the games he liked to play, but he played The College like a powerful queen piece, sent out to take me down.
While I’ve mentioned The College in some of my other posts, before now I’ve honestly been too afraid to say very much about them or what they did. Like many medical regulatory bodies, The College has earned a reputation for being “draconian” and “kind of evil”, in the words of two experienced lawyers who tried to help me in my case. Even though The College has already revoked my medical license and erased me from their register, I’ve been told that they will continue to monitor me. So, even now, I live in fear of what they might do.
Yet, after considerable thought (and therapy), I’ve decided that it’s time to say more about the role that The College played in the trauma I experienced these past years. The practices of medical regulators like my College affect the lives of many physicians in destructive ways. This should be causing alarm and prompting calls for reform, just as we have seen for the military, the police, and the criminal justice system. Now should be the time to hold the system accountable. However, most of my professional colleagues aren’t aware of how bad things really are, and those that do know have largely been shamed into silence. The wider public certainly has no idea just how powerless physicians are in the face of their regulators, and at most have only heard that there is a growing epidemic of physician mental illness and suicide. They would have no way to know of the connection.
So different from the practice of medicine itself, the practice of regulating medicine is egregiously one-sided and unwaveringly adversarial; it is not designed to diagnose and treat problems. Unlike even the practice of law in the civil or criminal justice systems, there are no checks and balances to try to make medical regulatory processes fair — there is no supposedly neutral judge or referee. Regulatory investigators present curated evidence to decision panels of community members and paid doctors who have no real legal training, are far from impartial, and whose motivations are considered suspect by many physicians. Prosecuting lawyers have complete reign, while neither the accused physician nor their lawyers are even allowed in the room to present their case. Life-changing decisions are made behind closed doors, while the physician whose life and career hangs in the balance is locked out and can only wait for official word to be sent by letter.
During my own experience of this process, it became very clear that The College had no interest in the truth of what had happened to me. They did not want to know about my abuser’s criminal record, his status as a registered sex offender, or the details of his abuse and assaults of myself and other women. What they wanted was evidence that I had a sexual relationship with him; that it was coercion and rape was no matter.
For the most part, all that my lawyers and I could do during the years that I was under investigation was write letters to The College — several of which I’m not sure that anyone actually read apart from their investigator. I have no confidence at all that the information contained in those letters was considered by the panels that were supposedly judging the events of my case and deciding my fate. And, when it finally got to the point that there might be an opportunity for my lawyers and I to present the complete facts of the case, the financial and legal threats were made too great by games played by The College’s lawyer. I was bullied and threatened with costs and risks I could not afford. (I did my best to write about this in a previous post, but at the time I was not in a good mindset and didn’t do a great job of fully explaining what happened. Maybe I’ll try again soon.) So, in the end, The College avoided having to make a real judgment because they made the process inaccessible.
If you read what The College released publicly about my case, it is nearly unrecognizable compared to the actual events. Their official statement is true only in a very technical sense, in the same way that, on average, each person has approximately one testicle. There are many things that The College uncovered in their own investigation that they left out, I assume because those facts could undermine their intention to paint me as an abuser of a patient. When I brought some of these facts up publicly, The College sent a letter demanding that I respect the confidentiality of my rapist.
Even before The College started their investigation, I had already lived through prolonged trauma at the hands of my abuser. However, I came to see The College as just as predatory and in many ways the betrayal by my supposedly empathetic profession was harder to endure. It was the hopelessness, the re-victimization, and the realization that I was caught in an all-powerful system that could not be stopped once it became invested in ensuring that I was guilty.
There were multiple times during The College’s investigation of me that I very seriously considered ending my life. I admit that I came closer to suicide during those years than when I was at my most desperate to escape from my abuser’s control. Had it not been for my husband and all the support that he gave me, I’m quite sure that I wouldn’t have lived through The College’s process.
Physicians hear rumours about what happens to colleagues who find themselves in their regulator’s spotlight, but those stories are often piecemeal and shrouded in secrecy. The rumours had been enough to make me too afraid of The College to ask for help when I really needed it to escape from my abuser’s violence. Now that I’ve lived through The College’s process myself, I know that their reputation is earned and that my fear was justified.
Because I’ve been willing to talk about my own experience, I’ve had the opportunity to hear much more detailed accounts of other physicians’ experiences with their regulators. Each story has told of a drawn-out, accusatory, shaming process that had a myriad of negative effects on each doctor’s mental health. The most unsettling stories were told by the people left behind after a physician ended his or her own life. More than once, I’ve heard someone say that it was the regulatory body that drove the physician over the edge.
There is considerable research to back up the conclusions of these hushed, personal anecdotes. Studies report that physicians under regulatory investigation describe being subjected to protracted, blame-focused processes that immediately assume guilt and act to prove it. Some doctors describe regulatory processes as traumatizing, or equate them to life-threatening illnesses. Too many physicians simply don’t survive them — very literally. Recently, the alarming number of physician suicides while under regulatory investigation prompted an internal review in the UK. Coroners’ inquests have called for medical regulatory reform, and bereaved colleagues and families have started petitions to ask for government intervention. Despite all this, medical regulators continue to ignore the central role that they themselves play in physician mental illness and suicide, and fail to make changes that would strike at the heart of the matter: reforming their practices to ensure that they are fair and accountable.
My experience with The College has left permanent scars. I’m still scared to open my mailbox and feel relief every time I don’t find an envelope with their logo on it buried in the junk mail. Still, I don’t want to be silent about what I now know of the pathogenic practices of medical regulators and the grim outcomes that they lead to. That’s why I’m planning to say more about the darker impacts of medical regulation in future posts — that is, if The College doesn’t find a way to shut me down. I hope that others will join in the conversation, because unless medical regulatory practices are reformed and rebalanced, the impacts of their deadly games will continue to mount.