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APRIL 2010: Stress Points

Balancing Life and Work

Elizabeth TillinghastAfter spending a good deal of my professional life trying to help people overcome emotional or psychological obstacles to success and satisfaction at work – mostly among lawyers – I thought I could write about challenges facing physicians with relative ease.

But the emotional or psychological challenges facing lawyers and physicians are quite different. Each profession has a distinctive profile of psychological challenges. Lawyers have to struggle with personal issues involving aggression and their response to rules. Also procrastination is a serious problem for lawyers because the law is full of deadlines. An attorney who misses a court date may seriously jeopardize his client’s case; he may even put his professional license at risk. Yet procrastination isn’t as problematic for doctors. Although patients may get irritated with doctors who are chronically late, physicians themselves don’t tend to view their lateness as a problem.

In continuing my quest for a relevant topic to address to an audience of doctors, I also considered money. Money is highly charged emotionally; many of us do have problems managing it. Again, the difference between doctors and lawyers in terms of money is interesting to note. Lawyers are usually much more personally involved than doctors with managing the financial aspect of their work. As lawyers advance professionally or go out on their own, they have to market, generate business, set rates, and collect payment from reluctant clients. This is rarely true for physicians (with the exception of psychiatrists). Most doctors either get a salary or work in a group practice where someone has been hired to deal with all of the unpleasant aspects of billing and collecting payment. Although doctors undoubtedly have personal hangups around money, they usually don’t have to tackle those problems directly to succeed professionally.

The psychological stress points for physicians seem to center on issues of caring.

Doctors routinely become key players in human dramas that are highly charged emotionally. We need to absorb a lot of emotional shock without becoming either so cut off as to seem uncaring or so overwhelmed with feeling that we can’t work effectively as physicians. Those two extremes are the Scylla and Charybdis of medical practice.

Although doctors are supposed to take care of patients, and be caring, the reality is that we often have to hurt people in the course of trying to help them. Putting IVs in children, giving cancer patients chemotherapy, doing any number of complex medical procedures: 
All of these may involve causing serious discomfort, or even pain. We may cause great emotional distress in our patients as well by giving them terrible news. Trying to be caring while causing pain is no easy task, yet it is an essential part of a physician’s job.

All of us have gone through very tough training before becoming full-fledged physicians. Many of us may have been motivated in part by the sense that working in medicine is meaningful and makes a positive contribution to the lives of others. Although lawyers and businessman may make more money, and money can confer a certain status or prestige, doctors often rely less on money for self-esteem than on the sense that they are doing good and are seen as good by others. That’s part of the compensation for all of our work and self-sacrifice, the pay-back. Unlike businessmen these days, we get to think of ourselves as the good guys. The sense of being good helps lift our self-esteem.

Now that assumption is being challenged. Doctors are a central part of the health care system, a system that is now seen as seriously flawed and in need of dramatic reform. Furthermore, some physicians have been criticized for developing overly close ties to drug companies. The implication that doctors may prescribe one medication rather than another to benefit financially is a stinging accusation because it implies doctors may be putting their own interests ahead of what’s best for their patients. The bad press about the flawed health care system and physicians who seem to have been “bought” by drug companies may strike at the self-esteem of all physicians.

How can we make sure we take care of ourselves when our professional identity is centered on the ideal of taking care of others? Taking care of others is fine, but there may be times when we would like to be taken care of ourselves. The longing to depend on others is part of being human; we’re not immune. At times this seemingly endless demand to address the needs of others may stir up a little resentment.

To counter this, it is critical that we take care of ourselves. At some point, we need to go home, spend time with our families, and replenish ourselves with whatever gives us pleasure. Figuring out how to balance personal life with work is a challenge for people in other fields as well. No doubt about it: People in many fields put in long hours at work. But for doctors, saving enough time and emotional energy for one’s personal life may be particularly difficult because that comes into direct conflict with the professional ideal of taking care of others.

Women physicians may have to contend not only with that medical ideal, but also with the myth of the motherhood ideal. Mothers never put themselves before their children; they meet the needs of those in their care before addressing their own. This vision of the ideal mother is so pervasive that professional women are often expected to be motherly toward others at work. Even if we don’t consciously endorse that myth, we may well be affected by it: We feel good about ourselves when we sacrifice ourselves to take care of others.

As I contribute articles about the stress points in our lives as healers, I invite and welcome your input about the challenges you face. You can reach me through et41@columbia.edu.

Elizabeth Tillinghast is a psychiatrist and psychoanalyst who also has a law degree. She has published articles about how lawyers and other professionals can overcome psychological impediments to success and happiness at work. She is on the faculties of Columbia and Cornell medical schools. Contact her through et41@columbia.edu.