A doctor's life is not an easy one

Clinical training gives us the skills to deal with stress — up to a point. Help for the overwhelmed and their patients

By Dr Dave Rainham

It's almost morning. The pager drills its piercing racket into your brain. "NO" screams your mind, "Not yet!" You hardly slept last night — again. Now there are extra calls to fit in before you get to the office. How can you do a good job and stay on time? On the way to the hospital you remember the car needs servicing; you promised to be at your daughter's play tonight (and at the back of your mind lurks the worry about that abnormal pap smear that didn't get followed up). Your marriage is slowly falling apart, you worry what your teens are up to and there's no time to visit or help your ailing parents.

When you finally get home, the easiest thing to do is pour a stiff drink and sack out in front of the TV. But you know your brain will start to churn again as soon as you try to sleep...

If you're feeling stressed — you're not alone. And it's not just the overload. Things are changing rapidly, and many doctors have lost the feeling of stability and security of only a few years ago. Untrustworthy, ignorant and inconsistent governments fiddle with healthcare and audit you unfairly and mercilessly. Expenses rise faster than pay, and patients are strangely less grateful and more demanding.

In return for the long and arduous training, the responsibility and the demanding and stressful nature of medical practice, physicians receive internal rewards — interesting work and the feeling of making a difference in people's lives. They used to get external rewards such as feeling appreciated and respected, having autonomy, job security and adequate pay.

Although most physicians today still feel reasonably content, many are working harder with less financial and personal rewards. And doctors get little sympathy from the public and media who still see us as "fat cats."

A recent survey showed that major stresses in medical practice included:

• Demands of the job — overload
• Time pressure — balancing work and family
• Finding coverage — especially for rural physicians and specialists
• Patients who are difficult, demanding, or critical
• Barriers to doing a good job — waiting time for imaging and specialists, shortages of hospital beds and nurses and the ever-escalating paperwork
• Lack of control over the direction of healthcare
• Splits within the profession — specialists compete with GPs for financial resources which leads to less camaraderie and more mean-spiritedness

As well, each specialty reports its own concerns — surgeons crave more OR time, anesthetists must deal with cranky surgeons and rural physicians cannot get back-up or locums.

Physicians are blamed for escalating costs, but have to order tests to cover themselves. They're criticized for not taking enough time or showing interest in the patient, but only procedures are reasonably paid. Time spent getting to know patients or to educate them is not worth much. Many doctors feel like scapegoats for a poorly designed and under funded system — and it's happening all over the developed world.

It's not fashionable or comfortable for physicians to take the risk of assessing their own or their family's stress levels, although a regular "check-in" would be a good idea.

IS THERE AN ANSWER?
Clinical training provides us with skills, which help us to accept uncertainty and change, deal with emergencies, gather information and find solutions. Whatever stress we face, we can choose to trace the source of worry, identify our stresses and — when there are no solutions — to accept reality. We can learn to relax, we can decide to exercise and eat well. We can choose the way we describe what's happening and select coping attitudes of optimism, persistence, flexibility and learning. We can quit taking ourselves so seriously and find the humour in situations. We can improve our communication skills, enrich our marriages and relationships, and optimize our time and money management. We can find support, develop our spirituality and learn to enjoy hobbies and interests. We can decide on a purpose and find meaning in life that will lead to happiness. Easier said than done.

Still, it's hard to help our patients deal with stress if we ourselves find it impossible to cope. To care for patients effectively we must first care for ourselves.

Will the stress of medical practice sicken and even kill us — or will we thrive on the stresses and become stronger and happier? It's our choice!

Dr. Dave Rainham is a family physician in Waterloo, Ont. His book The Stress of Medicine and the Clinician's Stress Resource (45 pages of photocopiable, interactive material for helping patients deal with stress) are both available free by calling 519-571-7904, or visit www.stresswinner.com