Doctors Under Stress
“A young couple came to me full of hope that I could do something for their newborn baby. As I examined him, my heart sank. His condition was incurable. Can you imagine my feelings when I told these new parents that their son would never see? As I dismissed them from my office, I felt overwhelmed with emotion. But a moment later my next patient was upon me expecting a welcoming smile! That’s what I find stressful.”—An ophthalmic surgeon in South America.
PATIENTS don’t usually visit consulting rooms to consider their doctor’s problems. A patient’s mind is filled with his own need for help. Consequently, few people realize how much stress doctors live with.
Of course, everyone has to cope with stress, and the medical profession is not the only stressful occupation. However, since nearly everyone becomes involved in doctor-patient relationships in one way or another, understanding the stress doctors live with and the effects it can have on them is worthwhile.
Doctors start learning to live with stress early in life as they struggle for a place in medical school. But when medical training starts, it is usually an unforgettable jolt to the emotions. It is the beginning of a process that can change the medical student’s feelings, his very character.
Medical Training—A Shocking Experience
The traumatic first visit to the dissecting room can be as early as the first week of medical studies. Many students may not have seen a corpse before. The sight of naked, shriveled bodies in different stages of being cut open to reveal the anatomy can be quite repulsive. Students have to learn strategies to cope with their emotions. Often they resort to humor, giving each cadaver a funny name. What seems appallingly callous and disrespectful to an outsider is necessary to students who are trying not to think of the person that the body used to be.
Then comes clinical training in a hospital. Most people are not forced into contemplating life’s brevity until perhaps middle age. But medical students come face-to-face with incurable disease and death in their youth. One described his first experiences in the hospital as “disgusting to the point of revulsion.” It can also be quite shocking to students in both rich and poor countries when they first realize how often patients are denied needed treatment because there is not enough money.
How do newly qualified doctors cope with the stress? Medical staff often have to distance themselves emotionally from patients by depersonalizing them. Instead of referring to the person needing attention, the staff may say, “Doctor, there’s a broken leg in cubicle two.” This may sound comical if you don’t understand the reason for such a description.
Doctors are trained as scientists, but for many the greater part of their work consists of talking to patients. Some physicians feel unprepared for the emotion of doctor-patient relationships. As noted in the introduction, one of the most difficult situations for a doctor is breaking bad news. Some have to do it daily. People in crisis often need to give vent to their anguish, and physicians are expected to listen. Dealing with anxious, frightened people can be so tiring that some physicians suffer a type of burnout now called compassion fatigue.
Recalling his early years, a family practitioner in Canada wrote: “Work was flooding me: needy people wanting my time; distressed people wanting to off-load their distress; ill people needing my action; manipulative people pushing and pulling; people coming to see me; people pressing for me to go to them; people coming down the telephone wires into my own home—and even my bedroom. People, people, people. I wanted to be of use, but this was madness.”—A Doctor’s Dilemma, by John W. Holland.
Does the stress ease with the passing of years? Seniority usually brings more responsibility. Often life-and-death decisions have to be made instantly, perhaps on the basis of inadequate information. “When I was young, it didn’t worry me,” explains a British doctor, “just as it doesn’t worry youngsters to drive dangerously. But with age, you value life more dearly. Now, treatment decisions make me more anxious than ever.”
How does stress affect doctors? The habit of distancing oneself emotionally from patients can carry over into family relationships. Avoiding that tendency can be challenging. Some physicians are outstandingly compassionate in helping patients with their feelings. But how far can they go without suffering compassion fatigue? This is the doctor’s dilemma.
Coping With Difficult Patients
When asked about the stress of doctor-patient relationships, doctors often start by describing difficult patients. Perhaps you recognize some of the following types.
First, there is the patient who wastes the doctor’s time by rambling on without coming to the point and explaining what his problem is. Then, there is the demanding patient who calls the doctor at night or on weekends for nonemergencies or demands treatment the doctor would prefer not to recommend. Also there is the distrustful patient. Some people research useful information about their condition, perhaps by Internet, and this can be helpful. But such research may lead them to lose confidence in the medical expert they have come to consult. A doctor may not have time to debate the pros and cons of everything that such research turns up. It is frustrating for a doctor when distrust makes his patient incompliant. Finally, there is the impatient patient. He abandons the treatment before it has time to take effect, perhaps seeking advice elsewhere.
In some parts of the world, however, the major source of stress for doctors is not the patient but the lawyer.
Many countries report a surge in the number of malpractice suits against doctors. Some lawyers make frivolous claims to win riches. “They are sending medical liability insurance premiums soaring,” explained the president of the American Medical Association. “These lawsuits lead to other agonies as well. For a physician, a wrongful suit can cause great harm—embarrassment, loss of time, . . . stress and anxiety.” Some doctors have even been driven to suicide.
As a result, many physicians feel obligated to practice “defensive medicine,” making decisions based on the possible need to defend them in court rather than on what is best for the patient. “Practicing medicine from the position of covering one’s back is now a way of life,” said Physician’s News Digest.
As pressures on doctors continue to mount, many of them wonder what the future holds. Many patients have the same question, as they observe increased suffering from some diseases despite advances in medical science. The following article presents a realistic view of the future for both physicians and patients.
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COOPERATING WITH YOUR DOCTOR
1. Make the most of your time with your doctor by preparing how you will explain your problem fully but concisely, starting with your foremost concern
2. Avoid calling your doctor at times outside of office hours for nonemergencies
3. Be patient. Proper diagnosis and treatment take time
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‘EVEN ROUTINE CASES CAN BRING SATISFACTION’
“The gulf between medical practice here and in more developed regions is huge. Here, learning a profession is viewed as a way to escape poverty, and so studying medicine is popular. But there are many doctors and few jobs. As a result, doctors are paid very little. Few people can afford to see a doctor as a private, paying patient. I work in an obsolete hospital with a leaking roof and only the most basic equipment. Our staff consists of two doctors and five nursing assistants. We serve 14,000 people.
“Sometimes patients think I don’t examine them adequately, but when you have 25 patients waiting, you can’t afford lengthy consultations. Still, treating patients brings me satisfaction, even routine cases. For example, mothers often bring in their undernourished, dehydrated children who have diarrhea. They have lackluster eyes and anxious faces. I just have to tell the mother how to use rehydration salts, parasite medicine, and antibiotics. Once these take effect, the child starts eating again. A week later he or she looks like a different child—bright-eyed, smiling, and playful. The prospect of enjoying such experiences made me want to be a doctor.
“Beginning in childhood, I dreamed of relieving sick people. But medical training changed me in a way that I did not expect. I saw people die for lack of even the small amounts of money they needed for lifesaving treatment. I had to make myself unfeeling so as not to be affected by the sadness. Only when the cause of suffering was shown to me in the Bible did I understand God’s compassion and regain my ability to feel for others. I was then able to cry again.”
Dr. Marco Villegas works in an isolated Amazonian town in Bolivia