Medical Couples: Making It Work In Challenging Times


Medical Issues Brief

Oregon Medical Association

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 Oregon Medical Education Foundation (OMEF), OMA was able to provide the seminar free to 40 third and fourth year medical students. During four workshops in 2000, 24 medical students and their spouses participated. In February 2001, the workshop was presented twice. Eighteen physicians and their spouses participated. Responses are enthusiastic and participants urge the OMA to make it available statewide. From these encounters, Ms. Frisch has gleaned information which is shared below.


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. Independence, decisiveness, swift judgments and hard decisions go with that· territory. At home, these characteristics may not be compatible with full and open communication (this can occur at a very slow pace, often with many needed silences and interruptions), joint decision-making and the natural compromises that every couple and family face in today's busy and complex world.


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


    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

    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