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.
