Marriage and the business of medicine
Greg Hood, MD, Internal Medicine, 04:04PM Aug 14, 2011
Wives of sailors are often known to refer to the sea their chief competitor for their husband's attentions. Maureen O'Hara famously referred to the United States Army as her only rival in She Wore a Yellow Ribbon when visiting her estranged husband, played by John Wayne. Judging by how the practice of medicine is regarded and the impacts it can have surely it ties or surpasses these two preceding examples in the profundity of its effects. More so than in the past, a medical marriage may be wholly composed of those who are engaged in the business of medicine. Today the physician in a marriage may be of either gender, both may be physicians, or the spouse may work within the practice as staff or manager. There exists today such a complex variety of professional titles and responsibilities for couples in a physician marriage that all of the permutations almost defy description. At their core; however, physician couples face especially potent stress stemming from issues of professional strain, role conflicts, personality and time constraint issues. At their core, physician marriages, like any others, do have common themes. They also have common challenges. Ultimately, marriage is intended to be a quest for intimacy, and a rewarding personal refuge. Closeness, togetherness and human bonds are the goals and rewards individuals seek in such relationships. Precisely because a physician is daily engaged in a high stress field these features are critically needed within the relationship. Physicians set high expectations for themselves professionally. They challenge themselves in every patient encounter to fulfill the highest ideals. Physicians are charged by society, through their training and technology, with the performance on command of the "miracles" of healing in ways unparalleled in human history. They are also threatened daily with draconian consequences should they exhibit human fallibility. The inevitable limitations which the mortal world and human experience enforce upon the physician can leave them feeling anxious, self-conscious, and vulnerable. The consequences of such strain often carries over into the home life, both for themselves and, whether by intention or not, their spouse. By example physicians appear to live by the axiom that, "Doctors are supposed to care for others ... we're not supposed to need care ourselves" [1]. Unintentionally, this approach can shut out exactly those whom both wish to come in and whom the physician needs and perhaps even wants to come in. In a study of physicians' wives seeking psychiatric care, depression was the most common presenting diagnosis. Furthermore, "the chief precipitating factor in the spouse's illness was absence of the husband - the feeling of being excluded or left out."[2]. This of course, can be more than just physical absence, but also exclusion from life's details and decision making. Decision making skills do not always carry themselves over well from the office to the home. While the situation at hand may have an obvious conclusion, pronouncing this by immediate and final edict may miss the point entirely. As society moves ever faster, driven by technology's ever increasing pace, sometimes it is the journey to the decision which counts. Showing patience and allowing the partner to express their thoughts, followed by a discussion which evolves into the solution, even if it is unchanged, is a process by which one shares an experience with another, and through which respect is imparted upon the thoughts and merits of the other. It is essential that when a physician is home that such interpersonal engagement happen. It is counterproductive for the time spent at home to only be comprised of recuperation from exhaustion. Time, energy and effort must be fed into the marriage so that in its life it is healthy and flourishing as well. This exercise will commonly return more energy than it requires. Discussions such as that which is outlined above can be a means of sharing quality time and rendering one's attention and regard to one's spouse. Furthermore, they can be an exercise in "caring for" the marriage rather than "curing" the problem at hand. Understanding the difference between these two attitudes can initially be sublime but, ultimately, can have an inestimable impact on the tone and outcome of the marriage. Physicians are exhaustively trained to be dispassionate and clinically objective. When other human beings are only addressed in an objective manner then they remain, to a degree, strangers. These are not skills which enhance one's ability to be endearing, warm and supportive at home. Further, they can unintentionally serve to keep those at home, to some degree, as strangers. Indeed, left without balance by other efforts and traits a clinician's approach can unintentionally form a cocoon around the physician's psyche. Many physicians end up making life and marriage choices in response to unattended to loneliness when it is actually their own approach to their vocation which magnified the feeling back upon themselves. Paradoxically, a physician's need to serve others can have a negative impact on marriage. Physicians can engage in such a degree of self sacrifice that they are uncomfortable or unwilling to accept the sacrifices others make on their behalf. Habitual self sacrifice can induce personal problems which then metastasize into the marriage. While marriages involve willing sacrifices it is important to engage in balanced interplay and interdependence. Should the necessary elements and steps to form a complete, healthy, and intimate bond in a marriage not occur then there tend to be inescapable consequences. If the couple remains, at some levels, strangers to each other, then their individual rates and directions of growth often diverge. They may grow in different directions, or one may outpace the growth of the other, socially or cerebrally. Alternatively, one may atrophy, regressing towards one's own historical patterns or becoming prisoner to one's own innermost fears. What does this have to do with the business of medicine? Physicians engaged in the practice of medicine, running a business, are caught in an incontrovertible paradox. Physicians today continue to exhibit professional altruism and commitment of time without equal. Physicians today also face incomparable and mounting expenses and bureaucratic intrusions into their operation of their own practices. The impossibility of these circumstances begs the need a relief valve, a role potentially perfectly filled by the support of the spouse. It is essential to the successful conduct of the business of medicine that physicians nurture and benefit from the intimacy and support of marriage rather than allow the pressure to build unchecked. It is important to recognize that the physician, as a purveyor of the business of medicine, should gain from the endeavor. There is no way in which a physician suffering from the profession to the point that their personal life suffers abjectly ends up benefitting the profession, the business of medicine, or its clients, the patients. Consequences including the potential for medical errors, disruptions in the office dynamics, and the human toll all weigh in as parts of the business of medicine. [1] Gerber LA. Married to their Careers: Career and Family Dilemmas in Doctors' Lives. New York: Tavistock Publications, 1983. [2] Miles JE, Krell R, Lin T. The Doctor's Wife: Mental Illness and Marital Pattern. Int'l J Psychiatry in Med 1975;6:481-48. |
