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 medicaltraining, nights without sleep, rigorous exams and a demanding workload, youmade it, you became a doctor. You also have another full-time job, as a mom ordad. Now the reality has set in and you wonder how on earth you can continue inthe medical profession and have a balanced family life. It's not what youimagined. With increased patient loads, the stress of dealing with insurancecompanies and HMOs and piles of paperwork, you're burned-out, unenthusiasticand your personal life is suffering. You fulfilled your dream, but how can thisbe? Is it just you? What can you do?
"It is becomingincreasingly difficult to manage a medical career and a personal life, which isreally nonexistent and has been for some time now". One doctor says,"Most of the doctors I know are frustrated being in the profession. Manywould leave if they found a way to support their current lifestyles. Most areso locked into their earnings that they cannot conceive of leaving medicine,despite the unhappiness. Finding an alternative career that allows them to paythe 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 afancy lifestyle with bulging bank balances. Like working women in otherprofessions, financial priorities include childcare, loans, mortgages, familyexpenditures and so on. Even if available, cutting back hours simply isn't anoption for many many physicians.
To find an alternative isdifficult if not impossible a young doctor, only four years out of residency,in a low-paying specialty (family practice) and has a astronomical student loanpayments to make ($125K-something that the older physicians in previouspractice did not understand at all) which pretty much precludes a young doctorfrom decreasing their hours/workload asmuch as they would like to. And even if they could have afforded to just cutback on hours, the partners in their practice would not tolerate it withoutextreme penalty. Managed care changes, HIPPA laws, malpractice lawsuits andMedicare regulations have also contributed to physician stress. "I believethat medicine is incredibly demanding (even part-time). Patients expect far toomuch. Managed care expects us to solve unsolvable problems with less than 15minutes per patient", says another family practioner with two school agechildren. She goes on to say, "Despite working only 2-3 days per week, Istill feel like giving up medicine all together because of the awful workingconditions... I honestly don't know too many doctors who enjoy medicineanymore".
Another member describes herday, "I see close to 60 people a day in my ob-gyn practice. Don't ask howI do it because at the end of the day, my head is swirling. I do this becausethat is the only way I can make my overhead and actually take home enough topay for the nanny and student loans. It is ridiculous." So why practice atall?Many doctors still love whatthey do, love interacting with patients, love diagnosing them, teaching themand getting patients to take care of themselves. "It feels good when theytell me I'm the best doctor in the world... I love trying to figure out how toadd 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 comeswith a huge responsibility. I must be continuously vigilant that I ampracticing the kind of medicine that I was trained to do (i.e. being thoroughand spending time with patients). There are no shortcuts to providing goodcare. Hyper efficiency does not exist in the world of good medical care.. Andno one can sustain good medical practice when they are burned out.".
In the biggest study of marrieddoctors to date, the American College of Surgeons surveyed nearly 8,000 of itsmembers, 90% of whom were married. Of those, half had spouses or partners whodid not work outside the home. About a third of the double-income couples wereactually double-doctor duos, and in about a third of those marriages, bothpartners were surgeons. In fact, the study notes that something like 50% offemale surgeons are married to physicians. This is in keeping with currentmarital trends. Plus it just makes sense. Who's better atunderstanding the stresses and strains of a physician's life than anotherphysician? Luckily, there are more femalesurgeons than there have been before, so there are more aroundto marry.
And since medical students are busy particularly those training to besurgeons are more likely to socialize among their own. No wonder that the studysuggests surgeon-surgeon marriages are on the rise.
You'd think that two-doctorfamilies would be idyllic: not only are both parents well-paid and competent athandling Baby's late night fever spike, but they're also able to appreciateeach other's latest bit of O.R. gossip and compete to beat Gregory House at thecorrect diagnosis.
But, it turns out, not so much.Surgeons in dual physician relationships had greater difficulty in balancingtheir parenting and career responsibilities," than those who had partnerswho stayed home or worked in other areas, finds the study, which was authoredby Liselotte N. Dyrbye, an associate professor of medicine at the Mayo ClinicCollege. Specifically, two-doctor couples were more likely to delay havingchildren and to feel that their work did not leave enough time for a familylife.
For surgeons married to othersurgeons, the picture was even grimmer. They were more likely to report thatchild-rearing had slowed their career, and they were more "likely to stayhome from work to care for a sick child and more often surrogated theircareer" in favor of their partner's career, the study said. Half thesurgeons married to other doctors said they had experienced career conflictwith their spouse and only about a third of them thought they had enough timefor their personal lives. Closer to 40% of doctors married to non-doctors feltthat way. Despite this, individuals from the two-surgeon families felt about thesame amount of burnout and depression as surgeons married to non-surgeons. Thisdoesn't stop the study from concluding that "the higher prevalence ofdepressive symptoms and clinically significant lower mental quality of lifeamong surgeons married or partnered to surgeons suggests that the work-lifehurdles could be taking a toll on their mental health."
An extensive body of literaturedemonstrates that the life of a physician's spouse (until recently synonymouswith a physician's wife) is fraught with stress and links such stressesprimarily with the spouse's occupation. The role of physician conflicts withthe role of husband and father and that the structure of medicine makes thecuring and caring roles mutually exclusive. The role strain, role conflict,susceptible personality type and loss of self-esteem as stress factors. Many authors havetestified that marital conflict is a major source of stress in the lives of physicians'spouses. The role conflicts between the physician and his wife, particularlyregarding the division of time between professional and family tasks, seem tobecome rigid rather than negotiated. Over time, the spouse often comes to feelneglected, lonely and painfully aware of a lack of individual and personalmeaning in her life. In addition, the physician's status in the community andprofessional world often seems to contrast sharply with that of the spouse, whomay feel that she is "one down" and is the losing competitor in themarriage. Power issues, expressed through the physician's greater flexibilityand control over money and other resources, may contribute to marital discordbecause the wife's power is usually limited to family and social relationships.Thus, the physician's spouse often struggles with confusion over identity andthe effects of role strain.
The physician-husband'sdirective professional role, if carried into the home, may be a major source ofmarital stress, which in turn may lead to psychiatric disorder in eitherpartner. Many authors have identified psychiatric disorders such as depression,anxiety, suicidal tendencies and psychosocial stress as major health problemsfor physicians' many observed that physician's wives admitted to hospital fordepression or drug and alcohol abuse wereoften angry and hostile because they felt neglected by their husbands andemotionally unfulfilled .Also, physicians' wives may come under significant butperhaps covert stress because their concerns and complaints about their healthoften seem to be ignored or minimized by their husbands and other health carepersonnel. Despite being surrounded by medical expertise, physicians' spousesreceived surprisingly poor health care. According to a study physicians' wivesfelt that their husbands minimized their own families' medical problems.Medical crises often developed as a result of this attitude. In a comparativestudy of the number of obstetric, pediatric and psychiatric complications ofphysicians' wives and teachers-lecturers, it was observed that nurses onpostnatal wards failed to report mild psychiatric problems among thephysicians' wives.
In recent years the physician'sspouse has come under a new stress. Historically, physicians and their spouseshave held an honoured and unique place in society. However, this esteem for themedical profession is being eroded as its members become increasingly involvedin business and union-like activities. In response to this inimical environmentmany physicians work harder and show greater commitment to their patients, butat a cost to their personal life-style; many of the wives silently grieve theloss of public esteem and feel anonymous and forgotten by contemporary society.
