Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her subjects and high scores on her national exams. She would be a valued resident in the most competitive specialty training programs. Her goal is to become a primary care physician and offer her expertise to a diverse set of patients, leveraging the multiple languages she speaks fluently. But because she was born in a Middle Eastern country, she has a problem.
She wrote to me that she suddenly faces uncertainty about her status in the U.S. and about the possibility she will be forced to leave without completing her final year of medical school. Were that to happen, she would have wasted the time and the money she has already had invested. She accepted the reality that as someone from another nation, she would need to be exceptional to fulfill her dream. But now she worries that she could be required to leave no matter how well she performs.
And the same is true for nurses, laboratory technicians and doctors born in other countries but already established in practice in the U.S. The rules they will need to live by in the future are unclear and ever-changing. Which countries will be impacted? Will the requirements to leave apply to individuals on student visas and green cards and even to naturalized citizens?
Imagine how you would feel going to sleep at night worried about what you will read in the newspaper the next morning. Everything you value is at risk, including your health.
How anxiety is eclipsing fear
Fear and anxiety are closely related emotions, but they are distinct from each other. Increasingly, we are seeing individuals in our nation suffering from both.
Fear is caused by the anticipation and awareness of a specific danger or threat. Anxiety is an overwhelming sense of dread and apprehension, often without a specific cause. The result of either emotion is an erosion of a person’s confidence in their ability to cope with the threat. If you’re afraid of heights, you stand at the edge of a cliff and look down, overcome with fear. But once you walk away, the fear fades. In contrast, the generalized sense of uneasiness associated with anxiety stays with you, no matter what you do. It permeates your psyche, encroaching on everything no matter what you try.
Physicians deal with fear on a daily basis. We address the fear of a patient with a mass who is worried about cancer, or of a pregnant mother concerned about the health of her unborn child. In contrast to fear, anxiety in medical practice tends to originate from internal rather than external causes. And, as the well-documented relationship between anxiety and health shows, it expresses itself in vague physical symptoms such as insomnia or lack of appetite. People with high levels of anxiety are more prone to depression, heart disease, high blood pressure and diabetes. In addition, chronic anxiety also impacts their children and other family members. Like a chronic physical irritation, persistent anxiety eats away at self-confidence and a person’s sense of well-being. Left unaddressed, it produces deep psychological wounds and long-term damage.
Even physicians are feeling the anxiety
Many of the physicians practicing in the U.S. today — 27 percent, to be exact — were born in countries outside the U.S. Most came to the United States for training, often after completing medical school and residency in their home countries. And many have remained in the U.S. throughout their professional lives, becoming U.S. citizens and providing outstanding medical care for patients in underserved communities, including inner cities and rural areas.
But those born in other countries and currently pursuing training in the U.S. — even if they’ve worked hard and are at the top of their classes — can no longer be sure they will find jobs or even be matched in the training programs they desire. Academic achievement alone may be insufficient.
I recently heard from physicians worried that someone will turn on them, simply because of their ethnicity, their surname or the color of their skin. One doctor I know came to the United States as a child 35 years ago and became an American citizen as a teenager. If you ask him to identify his nationality, his answer is “American.” But he is plagued by a growing sense that people are looking at him and labeling him as something “other.” He told me about taunts his daughter had received at school, with her classmates telling her —
even though she was born in California — to go back to where she had come from.
The impact on people’s lives and health
I worry that under these circumstances, the only choice people will have is to narrow their social network and pull back from their local community — and, for that matter, their whole world. All of us who have walked down dark alleys or deserted city streets have felt the surge of adrenaline when danger seems near. Dealing with such heightened fear and anxiety day in and day out is emotionally exhausting and physically debilitating.
Patients tell me they’re worried, too. Some feel anxiety that their medical care will be compromised based on their appearance or religious beliefs. Others are anxious about what might happen to friends and families in other countries and the possibility they will never see them again. Still, others have described the sensation of feeling cut off from their past and their loved ones and of the emptiness it has created for them and their children. One patient wrote to me that his dad tried to visit here but was blocked from entering through customs.
In the United States today, this anxiety is growing, and growing fast. And again, unlike the anxiety clinicians are used to addressing, the cause for these patients is external, not internal. But the impact is the same. And as a physician, I worry about the long-term consequences for the health of individuals and society.
Why attention must be paid
Fear of attack from enemies around the globe who are jealous of our freedom and democratic values must be addressed to preserve the security of our country and its people. At the same time, we need to guard against taking actions that will generate anxiety that will destroy people, tear apart our cohesion as communities and degrade the health of our nation. The core values of the medical profession require physicians to treat every patient equally, with the same level of care and diligence. The best physicians are those that provide every individual with the same respect, care and compassion they would want for themselves and their families.
Our immune system recognizes that all parts of our body belong to the whole. When our immune system becomes dysfunctional, it begins to identify important parts of ourselves as “foreign” and attacks them as though they were invading organisms. The result is a debilitating “autoimmune disease” that saps our strength and produces pain and dysfunction. Anxiety at the societal level creates that same pain. It keeps people awake at night and harms the heart and soul of our country and our people. The remedy, for those giving care as well as for those receiving it, is compassion, respect and inclusiveness.
Wait too long to treat an immune disease, and the prognosis becomes much worse. The same is true for the recently created anxiety now growing right in front of our eyes. If it persists, we risk inflicting long-lasting and widespread damage not only on certain individuals but also on the entire country.
My grandparents set off by ship from Europe as teenagers seeking to find a better life in the United States. They arrived in the U.S. knowing they would never see their parents again. But they were nonetheless filled with optimism and hope that they would have a better life here, and that their children and grandchildren would, too.
What people are experiencing now is altogether different, and extremely unhealthy. My grandparents came face to face with very real fears when they set sail across the Atlantic to a new country. Today, we’re seeing a new phenomenon, a growing anxiety pervading and destroying individuals and families who already live here.
Robert Pearl is a physician and CEO, Permanente Medical Groups. This article originally appeared in Forbes.
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