Physicians are human, too. Like everyone else, they worry about their families, their futures and keeping up with the Joneses. Their jobs involve a high level of complexity, stress and anxiety. To make things worse, their profession no longer is held in the same high regard that it once was, and new pressures seem to emerge with each passing week.
The husband and wife team of Wayne and Mary Sotile have chronicled the changing world of physicians in a number of articles and books, notably the 2002 volume, The Resilient Physician: Effective Emotional Management for Doctors and Their Medical Organizations. The pair, both trained in therapy, has been doing this kind of work for many years. They run Sotile Psychological Associates of Winston-Salem, N.C., and have counseled and consulted with many doctors and medical practices.
The Resilient Physician is an exceptionally thorough analysis of the emotional lives of doctors. The Sotiles describe one of the most significant mental hurdles for many doctors today. Power is having control over ones own life, they write. Historically, physicians also enjoyed high levels of control. They ruled their workplaces, they typically were supported by a stay-at-home spouse, and they enjoyed high levels of autonomy. In other words, their professional lives were characterized by high demand and high control.
Not any more. Physicians today face excessive workloads and the mandate to speed upto do more work, learn new skills and adjust to an endless stream of changes that are not in their direct control, the Sotiles write. Now more than ever before, being a physician means encountering high-demand/low-control stress, both at work and at home.
This may explain why so many doctors are opting out of the field for jobs with more control and less stress.
The authors zero in on the psychological underpinning of physicians angst. An authority figure who shows such emotions as anger, depression and agitation, and attitudes such as cynicism, hostility and suspiciousness can negatively affect every individual in his or her path. For many physicians, the strained relationships and loss of support that result from mismanagement of their emotions proves to be the final ingredient in a recipe for stress, dissatisfaction and burnout.
One physician I know fits this description to a T. He had led a very successful practice for many years and was highly regarded by colleagues. He worked long hours, but tried to live a balanced life between home and office. However, as pressures mounted both from internal and outside sources, his behavior and performance suffered. So much so, in fact, that three members of his medical group left, leaving him to practice solo. His future is very much in question, and many of his peers are concerned about him personally. It is sad to observe, but he isnt alone since there are other physicians across the country suffering emotional distress.
The Sotiles offer clues for physicians to mull over so they can identify whether they are facing emotional crises. They write that if the doctor finds himself chronically frustrated with medical colleagues or administrators and if relationships with patients, colleagues and loved ones are generally more stressful than soothing, he needs to learn some new skills.
Anger management is discussed in one chapter, while negotiating conflict is thoroughly discussed in another. One chapter I found of great interest had to do with listening and communication skills. How many times have we heard a patient say about his or her personal physician, She doesnt listen to me? Its probably because the physician feels she doesnt have enough time to listen because of the pressures of staying afloat in todays marketplace.
There is ample proof to persuade any doctor that listening could be the best medicine for any patient. The authors cite the Bayer Institute for Health Care Communication study, which surveyed 1,500 physicians and patients. Out of that study came findings showing that patients who rated communications with their physicians as excellent were four times more likely to believe they had received excellent care than those who did not think their communications with physicians were good. Then the authors cite a study of 186 physicians and their patients, in which researchers found that medication adherence was actually better among patients of physicians who had busier practices. Those busy doctors, however, did other things better. They made definite follow-up appointments with their patients and were willing to answer all their patients questions clearly and directly.
The authors offer some suggestions to help physicians do a better job of listening. For example, they discuss setting aside distracting agendas, focusing on the person you are with, conveying an empathetic response, and summarizing in your own words what you think the person is saying.
Another chapter of great interest was Making your workplace a positive interpersonal culture. Here again communication comes into play, along with treating people with dignity and respect and placing the right people in the right jobs. The authors make the point that people are the strength of any organization, and they tell physicians that the most powerful determinant of their resilience is how they manage relationships with their colleagues.
The Resilient Physician is an excellent guide for any physician in practice today. Its a road map to a successful program to not only manage oneself but also run a dynamic and successful practice.