DOCTOR’S UNDER STRESS

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.

Compassion Fatigue
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. a site to visit