The Painful Truth: Physicians Are Not Invincible

Merry N. Miller, MD, K. Ramsey Mcgowen, PhD, Department of Psychiatry and Behavioral Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City.

South Med J. 2000;93(10) 

In This Article

Ways to Promote Health Among Physicians

The problems associated with physician impairment can result in serious distress, dysfunction, and even death. Addressing these problems should be a priority on both a personal and institutional level.[40] Training programs and residencies also need to be aware of the risks for psychosocial distress, particularly suicide, and take steps to address this problem.[8] Individual physicians also need to be aware of these concerns and address them on a personal level.

Although there is little empirical evidence for interventions specifically designed for physicians to address the concerns raised here, information does exist to guide attempts to reduce psychosocial problems for physicians. Some of this information comes from recommendations already suggested in the literature, some from the stress management literature, and some from reflection upon these issues.[41,42,43]

First, it seems important for physicians to practice what they preach to patients. Healthy life-styles are likely to benefit physicians as much as they do the general population. Simple things such as getting enough sleep, exercising, and seeing a physician for regular medical care (rather than self-treatment) appear logical. Setting appropriate limits and pursuing meaningful life activities outside of work are also necessary for physicians to have balance, emotional support, and buffers against the stresses of medical practice.

Second, it is essential to overcome the denial and machismo that currently characterize the profession. This means increasing awareness of the problems we have discussed. (How many physicians are aware that the rate of suicide for physicians is double the rate of the general population?) Finding ways to develop professional self-confidence, competence, and the ability to act with authority that does not also foster a sense of invincibility (which breeds denial) should be a top priority in training programs.

Finally, these changes will not be possible unless the current implicit definition of professional commitment and competence is challenged. Physicians need to accept the notion that professional competence allows for compassion toward other professionals and toward themselves. Recognizing distress in others, offering support and assistance to those in distress, validating the setting of appropriate limits by self and colleagues, and reducing the conflict between work life and family life could all further the cause of addressing these concerns.

To implement such changes will require institutional and personal commitment as well as a change in attitudes and expectations that pervade the profession. Initially, it may be difficult to endorse a model of professionalism that is not based on workaholism. Much thought and discussion will be required before an alternative conceptualization can be established that incorporates the essential elements of professional practice without requiring unhealthy self-neglect. However, given the detrimental consequences of a failure to do so and the potential for improving the lives of professionals if such an endeavor is pursued, we think it is time for this discussion to be taken seriously.

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