Becoming a Healer that Veterans TRUST with their deepest pain

Becoming a "Doc" is critical for helping veterans heal

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  • Military service members and veterans are suffering due to recent events in Afghanistan and the Taliban takeover.
  • If we want to help them heal, we need to build trust with them.
  • Understanding the difference between “Doctors” and “Docs” is the key to building trust with the military community.

As the Taliban moved back into power in Afghanistan, veterans across America posted heartbreaking messages on social media. The themes are clear: They are wondering if their service counted, they are asking if the sacrifice of people they love like family was all for nothing, and they are expressing urgent fear about those left behind. Given the recent events in Afghanistan and the emotional trauma that many veterans are experiencing due to the Taliban takeover, more of us will be expected to become healers for those in the military and veteran population.

To support them well, it’s critical that we understand how to become trusted “Docs” who can help them heal. To do this, we must become aware of the differences between a “Doctor” and a “Doc.”

There are two types of providers who work with veterans—“Doctors” and “Docs.” A “Doctor” is a person with a higher degree and expertise that is recognized in the academic community. This is the default term used for providers with advanced degrees in systems where veterans and first responders receive treatment, as I discuss in my latest book, WARRIOR: How to Support Those Who Protect Us.

However, calling a provider “Doc” often connotes a special kind of trust. The heart of the distinction lies in the role the provider assumes with his or her patients. As a highly trained Special Forces medic once explained to me, “Doc” is what soldiers call a trusted medic in their combat unit. He said there were three sources of medical care in the Special Forces: licensed MDs (referred to as “Sir”), medics who were unproven (called “medics”), and finally, the ones who could treat and heal other soldiers (called “Doc”) because “help was guaranteed when it was needed most.” A “Doc” is a person you can trust with your life. For many veterans, this is the meaning of “Doc.”

Warriors (service members, veterans, and first responders) have an exquisitely sensitive radar for figuring out where a given provider lands. Docs earn their trust and Doctors disproportionately fail to engage them in care. This critical distinction organized my approach to serving our nation’s warriors—rather than approaching them as a Doctor, I wanted to engage my patients as someone with the same heart as the medics they came to trust in the military. In fact, I now feel that the best compliment I can receive is a warrior calling me “Doc.” To clearly illustrate this distinction, I’ve created profiles to highlight the key differences between doctors and docs:

1. Doctors assume that their patients should trust them based on their many years in school.

Based on their training, they are confident they can help. Doctors are the identified “experts” who offer “treatments” to their patients. They generally do not engage with their patients outside of the doctor-patient role. Over time, because they see their patients only in the “patient role, doctors may develop a cynical, privately negative view of those they serve as “impaired,” which can spill over and show up in how they interact with their patients in the clinical setting. The core belief of a Doctor is this: Working with Warriors is my job. I use my education and training to offer treatment to help them recover.

2. A Doc sees working with warriors as their way to serve those who serve us all.

Docs are mission-driven, and they want to earn their patients’ trust by listening and learning. They typically see veterans as fundamentally resourceful and will often engage them outside of the narrow patient-provider role. Instead of engaging warriors in a one-up, one-down treatment relationship, Docs collaborate with them. Their understanding of the needs of their patients and the culture of service grows over time. The core belief of a Doc is this: Working with warriors is my calling. I want to get better and better at this over time.

You can sometimes identify a Doctor by a quick visual of their office and an observation of how they conduct their sessions. For example, in their offices, in addition to prominently displaying a collection of advanced degrees, they may have “their” chair, which looks different from the chair of a veteran patient. And sometimes, the designated patient chair is thoughtlessly placed in a way that will make a patient feel most vulnerable, with his or her back to the door. Doctors often direct the care of their patients and give explanations in language that is typical of the medical or psychological field, which may not land with veterans and first responders. For example, you might be in the presence of a Doctor if you hear him or her explain something as follows:

“Epictetus discovered that it is not what happens to us, but how we think about the things that have happened that causes depression. Negative cognitions result in cyclical maladaptive patterns of behavior. Over time, we develop cognitive schemas that become rigid, and need to be analyzed and challenged. Here is a thought-restructuring sheet that you can use to challenge your thoughts. In column A, you write down your automatic cognitions, and in column B, you write the automatic beliefs that go with each cognition.”

In contrast, a Doc might appreciate that there are at least six words here that would make most patients’ eyes glaze over, veteran and civilian alike: Epictetus, cognitions, cyclical, maladaptive, schema, analyzed. If we use abstract words like these, we are much less likely to engage our patients. In contrast, a Doc might say something like:

“Do you ever feel like you are stuck in a loop, like no matter what you do, you can’t get the result you want? Or do you feel repeatedly sucked into the same types of frustrating interactions with your partner or your coworkers? You might even feel repeatedly ambushed by panic attacks or driven to hurt those you love the most by attacks of rage. We all have a “mental map” that helps us figure out how to navigate our relationships. Taking a closer look at the map can help us to update our map and better navigate our way forward. In all likelihood, you already have the skills you need. It’s just a matter of connecting with how to use them in a different way. For example, even though your rage makes you feel out of control, remember that when you learned to fire your weapon, you learned to snap in, and to get really calm by controlling your breathing and gently squeezing the trigger between breaths. So, you have the ability to downregulate your body, and because of that, we can work on linking that ability to other challenges in your life.”

The issue isn’t necessarily the type of therapy someone offers. A Doc might also work from a cognitive behavioral therapy approach but would modify his or her language so that it would land with a veteran. Like combat medics, Docs have useful skills, and they deploy these skills in ways that connect with the language and culture of military veterans and first responders. As trust grows, a Doc becomes an extension of the tribe of those they serve over time (definitely not the tribal chief, but a trusted advisor).

The concept of doctors and docs relates to a podcast I heard on the work of Harvard Business School professor Francesca Gino. During the Hidden Brain podcast episode entitled “Rebel with a Cause,” Gino describes the hidden cost of expertise. She explains that she and her colleagues became “fascinated by this idea that experience could be costly because in a lot of our classes, they are actually telling our students that they should gain knowledge, that information is power, that experience is important.” They explored millions of data points that showed how experienced cardiologists behaved after the FDA announced that the way they were using certain technology was not good for their patients.

What Gino and her colleagues discovered is that the more experience the surgeon had, the less likely they were to change their behavior. She concluded that as we gain experience, we often feel like the expert, and we think that we know better, even when valid information sources tell us that we need to rethink our approach. This is the hidden cost of expertise: if we think we know the best way to approach our work, based on our many years in school, we may miss opportunities to see where we need to change our approach, sometimes radically.

3. Finally a third distinction is this: Along the lines of what Gino and her colleagues observed, Doctors are at higher risk of believing their first assessment to be accurate. In many healthcare systems, patients are asked to complete several intake forms, listing their symptoms and describing the challenges they face. Doctors are more likely to create a treatment plan based on this data and their first impression of a new patient. Conversely, a Doc understands that many patients, especially those who have suffered trauma, do not extend trust without taking time to develop it with a provider. A Doc understands that patients often hold “a story behind the story” in reserve until that trust is built. If you’ve ever had a patient tell you that they were far more distressed or suicidal than they appeared at first, this is an example of the story behind the story.

For many patients, the first story is actually a test of trust. A patient is often seeking to know whether you can be trusted to walk with them through their darkest valleys. They are asking themselves questions like…if I were to reveal what is really at the root of my pain – unspeakable things that burn me with shame – will this provider react with fear or horror, or will he or she hold their center and help them to heal? These are the kinds of understandings we need to hold, as healers, as we seek to support those who protect us.

Our nation’s war fighters are suffering right now, and they need an army of Docs to help them heal. This topic is the focus of much of my latest book WARRIOR: How to Support Those Who Protect Us. If you want to learn more, consider picking up a copy or learning about the Master Guide for Mental Wellness, a guided journey that helps healers gain the insights they need to become “Docs”.

(Author owns the copyright for this piece, and a variation of it was originally published on author’s Psychology Today blog).

A “Doctor” communicates that they are the “expert” in the room while a “Doc” builds deep trust with their patients

References

Hidden Brain, “You 2.0: Rebel with a Cause,” National Public Radio, https://www.npr.org/2018/07/23/631524581/you-2-0-rebel-with-a-cause

Springer, S. (2021). WARRIOR: How to Support Those Who Protect Us. Hidden Ivy Press.

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