Career Journey of Doctors and Physician Relationships
Physicians are a hardworking bunch and most of us never skipped a beat after high school, straight on to college, followed by medical school, residency and becoming an attending.
Medicine can trick you because we are treated as though we are infallible and the first 5 years out or residency can falsely feel like we are finally cruising. In fact, the more we are treated like gods the more pressure there is on us to not make mistakes. And that first half-decade is just an extension of residency – that’s when we actually learn how to practice medicine independently.
Physician relationships are heavily affected by the pressures that our careers place on us. In this post, I will talk a little about how this unfolds and some of the responsibilities we as physicians have to help prevent a nuclear breakdown of the household.
As physicians we must have a bit of emotional disconnect from our patients in order to prevent our own pains from being projected onto them. Imagine a psychiatrist who relives every one of his patient’s emotional traumas during every visit. Or imagine the trauma surgeon who cries during every pediatric case.
We are told that doctors can grieve in healthy ways and don’t need to develop any emotional distance. We are told that by showing empathy we can bridge these feelings. We are taught what to say and taught what to feel – I never knew that an emotion could be taught.
Coping mechanism can be learned, easier for those who have lived more emotionally mature lives in their youth and harder for those who have put their emotional evolution on hold ever since high school.
Serial emotional disconnection takes place when we see an onslaught of patients. 5-10 patients an hour, day after day. Mix in our own personal issues, the fight we had with administration, the late paper we must submit, the ever-growing to-do list and our feelings of guilt for not taking any time to eat better or exercise.
Transitioning to the home
When docs come home to their loves ones there is often no decompression time. We must make a very quick transition from who we were at work and what’s expected of us at home – the negative interactions at work are dismissed, or at best we have a few minutes to vent about them but not enough time or emotional quotient to cope with them.
It’s natural to want to do something fun when we get home, hang out with the family, interact with the kids or jump on Netflix. Reliving all the negative interactions, the bad cases or dealing with all the to-do’s is the last thing on a doctor’s priority list.
And just because our partner may be in medicine as well, it doesn’t mean that they can necessarily help us cope any better. This could be either because of our ways of dealing with work related stress or it might be because they have even bigger obstacles to overcome than ourselves.
The sole provider
When you’re the only person who brings in income, there is not only a higher sense of responsibility but even more pressure on you. I realize this now that I am single with no dependents and no need for the income. It’s as if 80% of the pressure has been relieved – the other 20% is the rush of patients, the fear of making mistakes and dealing with choice staff and colleagues.
Sadly there is no solution that I will be proposing to this problem. With a 2-parent household, one often takes on the income responsibility and the other runs the household.
The cumulative effect
The first 5 years as an attending are great because the rush of autonomy can push back a lot of the negative feelings of dealing with work.
Extrapolate this to 10, 20, or 30 years and it’s very easy for doctors to burn out of life. I burnt out with lights and sirens, experiencing panic attacks and nausea, the whole bit. Burnout is often used to describe our negative connection with work when, in fact, it affects everything outside of the job as well.
Other doctors might experience more subtle emotions which isn’t necessarily good, either. We might cope by distancing ourselves from family, neglecting our own peace of mind, health or comfort.
The cumulative effect of decades of dissatisfied feelings at work can eventually cause this life that we are building up to come crumbling down. Those divorces which happen 10-15 years into the attending career of doctors might be explained in this way – or not.
If you don’t get it, how could your partner?
The solution to ease the suffering of being a doctor isn’t to take off your scrubs, throw it at your medical director, walk out of the building and take a shit in the patient parking lot.
Can you accept that the work you do will make you feel emotionally depleted? Can you accept that there will be days when you love the work and feel high and days when you wish you had never gotten an MD?
If you are unable to deal with these emotions then you have to accept that you will suffer. Nobody suffers without consequences and the victims are either ourselves, our patients or our loved ones.
Doctors suffer in silence and some do it because they think it’s the right thing to do, others think that they owe it to the world and many just feel responsible towards their family.
They may not quite get why they are suffering. They justify it and move on. Their partners take the same approach. Cumulatively, it often will come to a head in some fashion.
We get treated how we treat ourselves
Strangers don’t know enough about us to know how we exactly treat ourselves, how highly we take care of our emotions and health or whether we do everything possible to minimize work trauma. However, our partners know us intimately, they take their cues from how we regard our ourselves.
We can send mixed signals to them if we let our jobs abuse us for a few years and all of a sudden aren’t willing to stand for it anymore. What do you mean you feel burnt out? So what if they yelled at you? Who cares if your boss is riding your hard? You can’t just cut back, we need the income! Can’t you just look for another job? How about you just cut back a little, maybe go down to 80% for a couple of months!
One doctor may not stand for being insulted, harassed, or abused at work. Their partners know this and can anticipate their reactions and help them process such work environment changes if they take place.
Another may be so caught up with work and the income that they don’t have the ability to look up to assess the situation. They disregard the abuse at work as normal or necessary. They dismiss their feelings of suffering because their family depends on the income. And any thought of leaving the career is immediately thrown out because their identity is heavily intertwined with being a doctor.
How to connect better with your partner
The process should likely start with yourself, how you treat yourself, what your standards are regarding a work environment and how you define a joyful existence.
Are you being held hostage by your MD degree or by those many zeros on your paycheck? I am not sure if financial independence would cure such problems but it certainly might give you the mental space needed to make better decisions.
Decreasing our reliance on our jobs starts first with disidentifying from it and next building a system to sustain our financial needs for our lifestyles. This can be either done by increasing our savings/investments or by reducing our spending.
I didn’t set out to get out of medicine or have a higher career satisfaction. I decided that I didn’t want to be so dependent on the income from my job. I adopted budgeting through YNAB and in that process realized that being a doctor is nothing but a job – healing and medicine have nothing to do with who my employer is or what degree I hold or how many lawsuits I’m involved in.
Without the pressure to perform, to earn, to constantly improve and judge your value based on external factors, you can gain some clarity. During such a process you will either realize that your relationship is all wrong or that you have a much easier time connecting with your partner.