Medical Couples: Making It Work In Challenging Times
Medical Issues Brief
April 10, 2001
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
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.
Although this has been changing, physicians are the sole decision-makers
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 cant 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
Maintain a healthy sex life
Get your own family doctor; have regular checkups Sleep
Time Management Time=Energy
Energy creating vs. energy depleting activities Organize
Schedule; don't over commit
Include yourself and your family in your list of priorities
Anticipate and prepare for situations
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
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
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