Doctors require balances and boundaries.
So, shall we limit our love?
How can we balance the investment in the relationship with our patients and avoid a burn-out?
An impossible tension
Although we know that doctors are only humans, we struggle with this knowledge!
The decision to choose this profession, was made often out of compassion for people in need. To finally get here, we had to invest a lot of time and energy. It might have been very costly in financial and personal ways. Dedicated medical specialists are not working as doctors, we are doctors. It has become our identity.
What is your identity?
The vast majority of medical professionals are driven by the urge to help others. We are aiming to improve our patient’s life and try to make the world a better place in this way.
We want to be good and to do good.
But, doctors are only humans and we require balances.
Why does this matter?
A doctor’s sense of self-worth might depend on their day-to-day achievements. This can go to the extreme, that we are feeling, great, when our patients respond to our efforts with improving health. The flip side is, that we feel rubbish or worthless when they don’t become better, despite our efforts.
With other words:
Sometimes we get a kick out of a positive result and feel on top of the world and at other times, when patients deteriorate, we feel like a fraud.
When we turn the results of our efforts into the tools for our self-validation, the base of our life is on shaky ground.
Doctors require balances and boundaries.
So, why exactly does this matter?
We are working in a high-pressure environment. Another decision every ten seconds to be made.
We are working in pear groups of high achievers, with the attitude, that failure is not an option.
Therefore, we need to protect ourselves, or we risk exhaustion and burn-out.
One cause of our struggles might be the lack of boundaries. When are we allowed to say “no”?
Doctors require balances and boundaries.
Typical coping strategies
Typical coping strategies are:
- Emotional withdrawal that might in the extreme, resulting in a cynical attitude
- Covering up of our emotions with substances
- About 14% of male and 25% of female surgeons in a study in America suffered from alcoholism.)
Bhattacharya K, Bhattacharya N. Alcoholism among Surgeons-Is It a Hidden Hazard? Indian J Psychol Med. 2023 Mar;45(2):204-206. doi: 10.1177/02537176221081780. Epub 2022 May 1. PMID: 36925485; PMCID: PMC10011852.
- A unique concern for physicians, however, is their high rate of self-treatment with controlled medications
Hughes PH, Brandenburg N, Baldwin DC Jr, Storr CL, Williams KM, Anthony JC, Sheehan DV. Prevalence of substance use among US physicians.
JAMA. 1992 May 6;267(17):2333-9. Erratum in: JAMA 1992 Nov 11;268(18):2518. PMID: 1348789.
- About 14% of male and 25% of female surgeons in a study in America suffered from alcoholism.)
- Self-sacrifice behaviour down to burn-out:
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Studies variably reported prevalence estimates of overall burnout or burnout subcomponents:
67.0% (122/182) on overall burnout,
72.0% (131/182) on emotional exhaustion,
68.1% (124/182) on depersonalization,
63.2% (115/182) on low personal accomplishment.
Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA.
Prevalence of Burnout Among Physicians: A Systematic Review.
JAMA. 2018 Sep 18;320(11):1131-1150. doi: 10.1001/jama.2018.12777. PMID: 30326495; PMCID: PMC6233645.
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Doctors require balances and boundaries.
What else?
Our patients depend on our professionalism, our support, guidance and compassion.
But so do we!
We need to take our needs as seriously as our patient’s needs.
We are not only allowed, but actually required, to assess our resources realistically.
When we are tired, we are prone to mistakes.
When we are distracted by other life events, we cannot focus on the clinical task at hand.
Yes, working hard through a period of grief, might feel comforting, because we can distract ourselves from the negative feelings, that we might have due to other circumstances.
But our work is not our ticket for a brighter future, not our value and not our numbing drug.
So what now?
The biblical term is: to love your neighbour as you love yourself.
This contains a call to mature acknowledgement of our needs. We need care, reflection, and sufficient pauses to be able to offer a high quality, professional support for the patients who come in need of our help.
Doctors require balances and boundaries.
What is our role here?
We are not the saviour of our patients. We cannot offer miracles!
Neither are we the judge nor teacher of our patients, the one who tells them off when they have made a mistake.
However, we are people who know a thing or two about how the body works. Let’s share this information with them. The image I like to use here is the image of a by scout who can read the map and can use a compass to guide his companion through unknown terrain.
In a nutshell:
Doctors require balance and boundaries.
Only when we take care of our needs in a mature, responsible manner, can we offer compassionate care and emphatic attitude to the patients in our care.
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