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Medical Couples: Making It Work In Challenging Times |
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Medical Issues Brief April 10, 2001 During the past two
years, OMA developed and presented workshops for medical couples who wanted
practical advice to respond to the increased demands on physicians' time,
decreased earnings and decreased autonomy. Nancy Frisch, a psychotherapist
and communication specialist in private practice in Portland, lead the seminars. Under a grant from the There are at least five important issues confronting
many medical couples: 1) Physicians are expected to devote long hours to their
patients, paperwork, and professional responsibilities. The result is often
fatigue, irritability and frequent absences from home. By necessity or habit,
these absences take their toll on the medical couple and their children in
terms of strained communication, guilt feelings, anger, resentment and even
estrangement. 2) Although this has been changing, physicians are the
sole decision-makers at work. 3) Physicians are valued differently at work than at
home. Families need emotional access to the physician and this includes their
undivided attention, affection and assistance. In the work-a-day world of medicine, colleagues,
patients and staff need a physician to perform efficiently, effectively and
with a significant degree of emotional detachment. Making these transitions
seamlessly and without stress is challenging at best; especially if there are
special needs within the family or call schedules are particularly grueling. 4) Over the past decade, physicians have seen their
practice incomes decline, they have been called upon to see more patients in
less tinle and to complete mountains of paperwork
not previously requiring their attention. During this same period the
expenses of operating a practice have increased. As a result, what physicians
are bringing home today is far less than it was a decade ago. In some
specialties the decreases have been so dramatic that many physicians have
been forced to relocate, go to work for medical organizations (such as
hospital systems), and in many cases their only choice was to retire. These
economic realities produce enormous financial pressures, as children grow up
and college educations become not just a far away dream but an uncomfortable
reality, and as house payments, property taxes, upkeep expenses, vacation
needs, and food costs "gobble up" what is left over after taxes.
What was once a profession hard work paid off, is
now one in which difficult lifestyle choices must be made even as longer and
longer hours at work are demanded. 5) Taking into account the first four issues above, and
the fact that physicians are not always the best communicators with spouses
and children because of a perfectionistic
psychological profile, the result can often be an emotionally charged, or at
best stressful home situation. So what makes the marital problems of physicians so
special? Dr. Charles R. Meyer, Editor-in-Chief of the Minnesota Medical
Association's publication, Minnesota
Medicine, doesn't think they are. But, he says, "Doctors are
peculiar. They're competitive, work-oriented, achieving perfectionists who
have endured long years of deferred gratification. They have withstood the
gauntlet of medical school and residency, learning by intimidation a deluge
of information about which they never feel quite secure. They emerge with a
finely honed sense of responsibility to their vocation and plunge into
practicing medicine." Frisch notes that, based on the OMA Medical Couples
workshops, there are differences between new-to practice and veteran physicians
in terms of how they address these issues: 1) Many new-to-practice couples are both physicians.
They share a perspective and an understanding because of their similar
training and the time they must spend trying to balance personal life and
career. 2) New-to-practice physicians see both the need for and
the role of balance between home and work. In particular, they seem to bring
to practice a more highly developed sense of leisure skills. For instance,
they are active in competitive sports, or they travel extensively whenever
breaks in work permit. And, these activities are closely tied to joint
interests of spouse and children. Instead of taking the weekend off to go
fishing or climbing with others, new-to-practice physicians will make it a
family getaway. What are some of the strategies for increasing
satisfaction in relationships with spouses and children? Frisch makes the
following recommendations: 1) Bring balance to your life;
build in leisure time alone with your spouse and alone
with your children. Let go of guilt about taking time off from work. Not only
will leisure activities nurture key relationships, leisure activity helps to
relieve stress. 2) Compare an
"ideal" schedule with your current schedule. Give
yourself permission to make incremental improvements with the goal of
increasing both personal and family time without significant disruption. 3) Work on
communication with spouse and family. In his book, Doctors' Marriages, physician
Michael Myers makes these suggestions: "How a
perceived problem is raised is crucial. If you bring up a concern in a
harshly dogmatic or accusatory way, you are almost guaranteeing that the
concern will be denied or argued ... Using the first person plural, being
tentative, and reporting feelings works better. Meyers advocates that spouses
get together as a couple regularly. "Many couples fmd
that they have their best talks outside the home because there are no
interruptions." 4) Decrease
perfectionism. The constant need to do more and the need to do
better are valuable personality traits in medicine. But delegation and
relaxation are equally important traits in a well rounded person. 5) Talk with
colleagues about what they have done successfully as
individuals and couples to increase satisfaction. Problem solving through the
sharing of common experiences is a well-recognized self help strategy. 6) Develop a
financially sound retirement plan with your spouse. Having
and achieving financial goals are hallmarks of a successful relationship.
Planning and executing a sound financial plan with your spouse strengthens
marital bonds and sets the stage for a successful transition to a couple's well
earned retirement. Remember, both of you worked for and earned that goal. To achieve well being in marital and family
relationships requires attention to the needs of others. But of equal
importance is the recognition and successful management of stress. Canadian
psychiatrist and expert on physician stress, Dr. Mamta Gautam spent a day
before OMA's video cameras providing insights into
this important issue. Below are edited excerpts of that conversation: OMA: How can
physicians tell if they are experiencing stress - particularly if they are
overly conscientious about attending to others' needs? Dr. Gautam: Well,
there are five what I call early warning signs of stress and in no particular
order, one is really an increase in physical signs and symptoms so when you
have a cold that lasts longer than it normally does it's now into the third
week and you just can't seem to shake it, second sign is an increase in
negative thoughts and feelings where you start to feel like you're not really
acting much by choice, things are happening to you, you're being forced to do
some things, you start to not enjoy things that you previously would have
enjoyed. A third sign of this sort of stress is increased problems with
relationships so when you go into the hospitals the staff that you normally
like and joke with and enjoy seem to say you know you're just more irritable
and you're not as much fun to be around. A fourth sign of stress fairly early
on in the process is an increase in bad habits and it's important to know
what your bad habits are and to take a minute and think about what do I do when I'm normally stressed out. And
finally the last sign is exhaustion when physically you're just overwhelmed and
you hit a day where you just can’t even get yourself out of bed to face
what's ahead. And left unchecked, all of those signs lead into burnout. OMA: So what
do you do to deal with this very significant problem? Dr. Gautam: I think
it's really important for physicians to know the number one cause of stress,
no matter whether it's personal or at work, is really the sense that in that
situation you feel like you have no choice, you feel like you have no control
at all. And the number one solution is to challenge that perception that you
have no control. OMA: What
can the physician do to prevent burnout from happening? Dr. Gautam: Well,
the most important one above all is to take care of you. The bottom line is
that you're no good to anybody else unless you're taking care of yourself,
things like make sure you have enough sleep, make sure you eat well, make sure
you exercise, make sure you take time to nurture yourself and to do something
you know very special to recharge and re-energize and get back on track. Dr. Gautam goes on to list ways to keep stress positive
since it cannot be completely eliminated. • Take care of yourself first Make
time for yourself Exercise Eat
well Maintain
a healthy sex life Get
your own family doctor; have regular checkups Sleep Indulge
yourself • Time
Management Time=Energy Energy creating vs. energy depleting
activities Organize Schedule; don't over commit • Set Priorities Delegate Include yourself and your family in your
list of priorities •
Anticipate and prepare for situations Professionally Personally •
Consider and use options Need a high "index of
suspicion" – if look for options, will find them Crucial to decreasing stress, because no
longer feel you have no choice • Learn
to say "NO" You can't please everyone; stop trying • Add
fun to work Slow down Don't rush life; you're dead a very long
time • Don't take your work home It will still be there when you get back
to it Give your family your undivided
attention • Take regular time off Planned-weekly, regular holidays; don't
wait for a crisis to force it Unplanned-"A Gift of Time" • Use
support systems Have at least one good friend Surround yourself with people who are
good for you Pets • Share
your stories You are in good company; you are not
alone Don't deny yourself support the very time
that you need it • Laugh more often Therapeutic use of hum or Keep humor files, share jokes, enjoy • Let go of the guilt Acknowledge it, let go of it, change the
message you give yourself •
Relaxation Techniques Multiple techniques available;
meditation; spirituality Practicing during "rehearsals;"
be ready for the "performance" •
Create a financial plan Stick
to the basic financial principles first: -Contribute early to retirement plans -Reduce nondeductible debt, such as a
mortgage -Institute a regular savings plan, with
preauthorized contributions Have a clear financial goal -Implement it;
reassess regularly •
Remember the 90:10 Rule Most of your reaction (90%) is not due
to the current situation Define the "history," and try
to rewrite it • Consciously set realistic expectations Acknowledge need to please
others, to be perfect, controlling |