October 30, 2011

Doc take the afternoon off let's get a drink and talk

My Doctor Needs A Doctor
By Melvin J. Howard

I was watching a episode of House MD which by the way is one of my favorite TV shows. What I find fascinating about the show is that it exposes all the flaws of the main character for the whole world to see not only in the work environment but in his personal life as well. We seldom forget that doctors are people to with their own problems from dating, family conflicts to business and professional set backs. Just imagine after years and years of intensive medical training, nights without sleep, rigorous exams and a demanding workload, you made it, you became a doctor. You also have another full-time job, as a mom or dad. Now the reality has set in and you wonder how on earth you can continue in the medical profession and have a balanced family life. It's not what you imagined. With increased patient loads, the stress of dealing with insurance companies and HMOs and piles of paperwork, you're burned-out, unenthusiastic and your personal life is suffering. You fulfilled your dream, but how can this be? Is it just you? What can you do?

"It is becoming increasingly difficult to manage a medical career and a personal life, which is really nonexistent and has been for some time now". One doctor says, "Most of the doctors I know are frustrated being in the profession. Many would leave if they found a way to support their current lifestyles. Most are so locked into their earnings that they cannot conceive of leaving medicine, despite the unhappiness. Finding an alternative career that allows them to pay the bills and add balance to their family life can be extremely difficult, especially when student loans can top $100,000. Many doctors aren't living a fancy lifestyle with bulging bank balances. Like working women in other professions, financial priorities include childcare, loans, mortgages, family expenditures and so on. Even if available, cutting back hours simply isn't an option for many many physicians.

To find an alternative is difficult if not impossible a young doctor, only four years out of residency, in a low-paying specialty (family practice) and has a astronomical student loan payments to make ($125K-something that the older physicians in previous practice did not understand at all) which pretty much precludes a young doctor from decreasing their  hours/workload as much as they would like to. And even if they could have afforded to just cut back on hours, the partners in their practice would not tolerate it without extreme penalty. Managed care changes, HIPPA laws, malpractice lawsuits and Medicare regulations have also contributed to physician stress. "I believe that medicine is incredibly demanding (even part-time). Patients expect far too much. Managed care expects us to solve unsolvable problems with less than 15 minutes per patient", says another family practioner with two school age children. She goes on to say, "Despite working only 2-3 days per week, I still feel like giving up medicine all together because of the awful working conditions... I honestly don't know too many doctors who enjoy medicine anymore".

Another member describes her day, "I see close to 60 people a day in my ob-gyn practice. Don't ask how I do it because at the end of the day, my head is swirling. I do this because that is the only way I can make my overhead and actually take home enough to pay for the nanny and student loans. It is ridiculous." So why practice at all?Many doctors still love what they do, love interacting with patients, love diagnosing them, teaching them and getting patients to take care of themselves. "It feels good when they tell me I'm the best doctor in the world... I love trying to figure out how to add quality in to the work I do every day" says one single mom physician.

Another member says, "what a privilege it is to practice medicine... But that privilege comes with a huge responsibility. I must be continuously vigilant that I am practicing the kind of medicine that I was trained to do (i.e. being thorough and spending time with patients). There are no shortcuts to providing good care. Hyper efficiency does not exist in the world of good medical care.. And no one can sustain good medical practice when they are burned out.".

In the biggest study of married doctors to date, the American College of Surgeons surveyed nearly 8,000 of its members, 90% of whom were married. Of those, half had spouses or partners who did not work outside the home. About a third of the double-income couples were actually double-doctor duos, and in about a third of those marriages, both partners were surgeons. In fact, the study notes that something like 50% of female surgeons are married to physicians. This is in keeping with current marital trends. Plus it just makes sense. Who's better at understanding the stresses and strains of a physician's life than another physician? Luckily, there are more female surgeons than there have been before, so there are more around to marry. 

And since medical students are busy particularly those training to be surgeons are more likely to socialize among their own. No wonder that the study suggests surgeon-surgeon marriages are on the rise.
You'd think that two-doctor families would be idyllic: not only are both parents well-paid and competent at handling Baby's late night fever spike, but they're also able to appreciate each other's latest bit of O.R. gossip and compete to beat Gregory House at the correct diagnosis.

But, it turns out, not so much. Surgeons in dual physician relationships had greater difficulty in balancing their parenting and career responsibilities," than those who had partners who stayed home or worked in other areas, finds the study, which was authored by Liselotte N. Dyrbye, an associate professor of medicine at the Mayo Clinic College. Specifically, two-doctor couples were more likely to delay having children and to feel that their work did not leave enough time for a family life.

For surgeons married to other surgeons, the picture was even grimmer. They were more likely to report that child-rearing had slowed their career, and they were more "likely to stay home from work to care for a sick child and more often surrogated their career" in favor of their partner's career, the study said. Half the surgeons married to other doctors said they had experienced career conflict with their spouse and only about a third of them thought they had enough time for their personal lives. Closer to 40% of doctors married to non-doctors felt that way. Despite this, individuals from the two-surgeon families felt about the same amount of burnout and depression as surgeons married to non-surgeons. This doesn't stop the study from concluding that "the higher prevalence of depressive symptoms and clinically significant lower mental quality of life among surgeons married or partnered to surgeons suggests that the work-life hurdles could be taking a toll on their mental health."

 An extensive body of literature demonstrates that the life of a physician's spouse (until recently synonymous with a physician's wife) is fraught with stress and links such stresses primarily with the spouse's occupation. The role of physician conflicts with the role of husband and father and that the structure of medicine makes the curing and caring roles mutually exclusive. The role strain, role conflict, susceptible personality type and loss of self-esteem as stress factors. Many authors have testified that marital conflict is a major source of stress in the lives of physicians' spouses. The role conflicts between the physician and his wife, particularly regarding the division of time between professional and family tasks, seem to become rigid rather than negotiated. Over time, the spouse often comes to feel neglected, lonely and painfully aware of a lack of individual and personal meaning in her life. In addition, the physician's status in the community and professional world often seems to contrast sharply with that of the spouse, who may feel that she is "one down" and is the losing competitor in the marriage. Power issues, expressed through the physician's greater flexibility and control over money and other resources, may contribute to marital discord because the wife's power is usually limited to family and social relationships. Thus, the physician's spouse often struggles with confusion over identity and the effects of role strain.

The physician-husband's directive professional role, if carried into the home, may be a major source of marital stress, which in turn may lead to psychiatric disorder in either partner. Many authors have identified psychiatric disorders such as depression, anxiety, suicidal tendencies and psychosocial stress as major health problems for physicians' many observed that physician's wives admitted to hospital for depression or drug and alcohol abuse were often angry and hostile because they felt neglected by their husbands and emotionally unfulfilled .Also, physicians' wives may come under significant but perhaps covert stress because their concerns and complaints about their health often seem to be ignored or minimized by their husbands and other health care personnel. Despite being surrounded by medical expertise, physicians' spouses received surprisingly poor health care. According to a study physicians' wives felt that their husbands minimized their own families' medical problems. Medical crises often developed as a result of this attitude. In a comparative study of the number of obstetric, pediatric and psychiatric complications of physicians' wives and teachers-lecturers, it was observed that nurses on postnatal wards failed to report mild psychiatric problems among the physicians' wives.

In recent years the physician's spouse has come under a new stress. Historically, physicians and their spouses have held an honoured and unique place in society. However, this esteem for the medical profession is being eroded as its members become increasingly involved in business and union-like activities. In response to this inimical environment many physicians work harder and show greater commitment to their patients, but at a cost to their personal life-style; many of the wives silently grieve the loss of public esteem and feel anonymous and forgotten by contemporary society.