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How to approach a struggling colleague
July 12, 2023
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Frequently asked questions regarding approaching a struggling colleague

Christina J. Wong, M.A. Clinical Psychology

There is general consensus that the physician population is experiencing unacceptably high levels of anxiety, depression, burnout and suicide risk that have been exacerbated by the recent COVID-19 pandemic. At the same time, however, there is historically low utilization of mental health resources among doctors. Support from colleagues can often be the most accessible and acceptable source of support. The STOPStigma: It’s Okay to Not Be Okay campaign is advocating for peer support as one of the most effective ways to support struggling colleagues and direct them to resources that can help with burnout and mental health challenges. 

What are the barriers to reaching out to a struggling colleague?

It has come to your attention that one of your colleagues may be struggling. Here are some reasons why you might be hesitant to reach out to them:

“It’s not my job to reach out to them; there are supports in place if they need them.”

Keep in mind that physicians affected by psychological distress tend to avoid supports. According to a recent study by the American College of Emergency Physicians, more than a quarter of participants avoided seeking established services due to fear of professional repercussions. Many physicians feel the need to maintain their role as health care team leader and that it is countercultural for them to admit that they need help. If you are on a team, it is within your role to check in with your team members. Caring about who you are working with is important when there can be severe adverse consequences for this population.

“The stress that they’re experiencing is normal; it’s something every doctor has to go through.”

Starting in medical school, physicians are strongly programmed that those who persevere through challenges and hardship are the ones who succeed. Maintaining a stoic demeanor can be perceived as a valuable contributor to advancement in the medical profession. In such a high pressure environment, suppression is often used as a coping strategy for stress management. However, this culture includes denial of physicians’ mental health and emotional needs and internalization of self-care as selfishness. Peer support can mitigate these cultural factors by providing physicians a space of psychological safety to talk about challenges without the need to fix their problems or suppress their emotions.

“What if I’m reading into their situation and there’s nothing to be concerned about?”

It can be valuable to trust your experienced intuition to notice when something is irregular in an individual. In the event that you misread a situation, your colleague is likely to be grateful for your thoughtful attentiveness. Regardless of their response, you are helping to create a culture in which checking in with colleagues is normalized in your organization. 

“What if they have a negative response?”

There are a variety of ways in which someone may respond to you reaching out to them. They may say that everything is fine or act defensively, in denial, or embarrassed. However, if you approach the situation non-judgmentally, you are not responsible for how people react to your act of reaching out. It is important not to be driven by the fear of how your colleague will respond. You can’t measure the success of your interaction based on their momentary reaction. The impact could extend beyond the immediate exchange. In the long term, your initial connection may facilitate future gains after more safety is built for that person. Ultimately, it’s not about getting the reaction that you want, but communicating something important to your colleague. 

“I don’t want to be put in the position where I have to report something that they’ve disclosed.”

With peer disclosure, there’s the question of what obligation there is to understand how the struggles your colleague is facing impacts their work. It is not within your role as a colleague showing support to determine competency – in this interaction, you will not have enough information to make those conclusions. It is natural as a diagnostician to analyze the situation and aspire to get to the bottom of things, but this is not your role here. There are few situations in which it will be obvious from a brief conversation that an individual is in crisis and is unable to take care of themselves or others. This serves as a reminder that the purpose of approaching a colleague is not to fully understand their situation but to show them care.

“I wouldn’t know what is appropriate to say – can I really offer them solutions?”

Feeling ill-equipped to offer solutions and help to your colleague may be an obstacle to starting the conversation. However, offering advice is not the goal of this interaction. It can make a world of a difference for someone to recognize that their struggle is being seen, and the people around care about what they are going through. There will be times when a colleague may not be able to communicate what they need from you, but your action can plant a seed so that when they do need support, they will know you are someone they can reach out to.


American College of Emergency Physicians (October 2020) Mental Health among Emergency Physicians

Goldfarb, A. (2020, July 28). How to Ask if Everything Is OK When It’s Clearly Not. The New York Times

Hu, Y.-Y., Fix, M. L., Hevelone, N. D., Lipsitz, S. R., Greenberg, C. C., Weissman, J. S., & Shapiro, J. (2012). Physicians’ Needs in Coping With Emotional Stressors: The Case for Peer Support. Archives of Surgery, 147(3), 212–217. https://doi.org/10.1001/archsurg.2011.312

Kevin. (2017, June 25). How to respond to physician burnout in a colleague. KevinMD.Com. 

How to approach a struggling colleague

Christina J. Wong, M.A. Clinical Psychology

How should I go about approaching my colleague?

It has come to your attention that one of your colleagues may be struggling. You should approach them in a relaxed and private space. Here are some steps that you may consider when reaching out to them:

ASK – Approach the conversation with curiosity., Bbe specific about what you have been seeing, and ask open-ended questions.

The more descriptive you are descriptive about specific instances you have observed that have caused concern, the less you can misinterpret what’s been happening. This shows that you are coming to the conversation non-judgmentallynon-judgementally. You’re not telling the other person how they feel, but rather you’re initiating an opportunity for them to address the change.

Don’t say: 

“I notice you’ve been struggling;, is everything okay? (this makes a non-specific reference to “struggling” with a closed ended question that could be answered with, “I’m fine.”)

Say instead:

“I notice you’ve come late to shift a few times., I’m wondering what’s been going on for you?”

“I’ve noticed you’ve been extra fatigued lately. T, tell me about how you’ve been doing and if I could give you some help and support.”

“I’ve heard you being harder on yourself these days, like when you said X, I’m wondering how you are.”

LISTEN – Make active listening and being present your priority.

Demonstrating understanding and care through listening is the core goal of a peer support interaction. Physicians are trained to fix whatever issue they are presented with, but that may come at the expense of active listening. For this approach, it is important to suspend the desire to problem-solve or give advice. The situation is likely complex and not fully understood and resolved in one conversation. Simply listening can help someone begin the critical step of gaining perspective in their situation.

Tips to listen actively:

  • Do not become preoccupied with what you’re going to say, because it can be a significant distraction from showing empathy. Even if you sit in silence, your facial expressions and body language will convey your empathetic reaction. Validate that their situation is painful. This demonstrates that you are actually burdened together.
  • Reflect their experience using specific adjectives describing how you understand they’re feeling (e.g. exhausted, conflicted, burdened, overwhelmed, daunted, unsettled). The more specific, the better. 
  • Make use of non-verbal minimal encouragers (nodding, leaning forward slightly, open posture, facial expressions that convey understanding)

ENCOURAGE – Reinforce that you are looking out for them, and care about them as a member of the team. 

Some things you might say to encourage:

“You deserve to feel better.”

 “You deserve to care for yourself.”

“I know these feelings will pass.”

“I get why you’re feeling this way.”

“I don’t have answers, but I want you to know I’m here and I care about you.”

“Seeking help for your own problems can help improve the care you give your patients.”

REFER – Encourage your colleague to enlist other support.

People in difficulties often isolate themselves. Emphasize that seeking help is not a sign of weakness or failure but a sign of health. Reassure them that they can find a way to function with less anguish.

  • It may be helpful to ask them about the resources they already have such asincluding their support network and from whomwhere else they could seek support.
  • If appropriate, encourage them to identify their next steps.

FOLLOW UP – Checking in again can instill confidence that your concern for their situation is genuine. Don’t insist on knowing what has happened, but instead let them know that you’re still available to listen and help.

Proactive peer support can both alleviate stigma surrounding physician mental health and burnout and can promote a culture of care and safety around vulnerable conversations.