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As a physician, it’s important to be in the present 100% of the time. “Writing the wrong number on a prescription pad is an extreme, but important, example of what could happen if a physician is distracted,” says consultant Donna Singer, Donna Singer Consulting LLC, Newton, Mass.
Dr. Chabra
Sanjay Chabra, DO, director of rheumatology, St. Jude Heritage Medical Group, St. Joseph Health, Fullerton, Calif., says, “We must give patients our full attention so we don’t miss out on any important details that could be needed to make a diagnosis or a change in treatment. Patients will notice quite quickly if we aren’t listening to them, which will break the patient–doctor relationship.”
Diagnose the Problem
“If a personal problem is on your mind, you need to determine if you can indeed be present for the patient,” Singer says. Depending on the physician, some methods work better than others.
Physicians should not feel embarrassed or ashamed when grappling with a personal problem, given that everyone has them, says Randy A. Sansone, MD, professor of psychiatry and internal medicine, Wright State University School of Medicine, and director of psychiatry education, Kettering Medical Center, Dayton, Ohio. “Physicians may feel a loss of control in stressful personal situations. They are not functioning as the dispenser of healing, but receiving the healing, which can culminate in uncomfortable feelings of vulnerability due to being dependent upon others,” he says.
If possible, the best way to release a problem is to take actions to resolve it. “This means diagnosing the problem and creating a treatment plan, just as you might for a patient,” advises relationship expert and author April Masini, Naples, Fla.
If it’s a fight with a spouse or significant other, make time to meet and talk with them. Simply scheduling a date—whether it’s a 30-minute phone call at lunch or a dinner date at home, will alleviate some of the anxiety about the problem hanging out there. If the personal problem involves money, for example, scheduling a meeting with an accountant may help.
Jeanette Raymond, PhD, clinical psychologist and psychotherapist, Los Angeles, offers a different approach. She advises writing down the personal problem. “The problem is made real by writing it down; it is taken seriously, dissipating anxiety,” she says. “The unconscious brain will now be working out solutions without the physician’s conscious self being invaded.”
Research shows that when a problem is put into words, it gets clarified, a first and vital step.1,2 Now that the physician has had a chance to note what he or she is feeling about the problem, the emotions can be dealt with separately from the issue itself.
Regardless of what method you use, Singer states the obvious: Get enough sleep, exercise and eat healthy. “This may sound silly, but physicians often do the least self-care of any profession,” she says. “Remember what they say on airplanes: ‘Put your own oxygen mask on first; then help others.’”
Another way to help you refocus, Dr. Raymond says, is to use phone apps that:
- Record mood;
- Have video and audio of natural beauty with peaceful sounds;
- Have recordings of the physician reminding him/herself to monitor stress and take regular five-minute mental breaks; and
- Play calming music—something known to help with anxiety and frustration.
Handling an Urgent Problem
Sometimes, there is no time to think, just to react. If the physician is feeling stressed or overcome with grief, anger or fear or is just overwhelmed, “he or she needs to take a five- to 10-minute time out,” Dr. Raymond says. “If it’s a family problem, then take time to make a phone call and arrange for the family member to receive attention and appropriate care.”
Dr. Chabra is privileged to work in a group with five rheumatologists who can cover for each other if necessary. “Each week, we block time on the schedule for each of us to handle non-direct patient care issues,” he says. “So if one of us needs to tend to an urgent matter during patient care hours, a colleague can fill in.”
Dr. Raymond works with many physicians who are perfectionistic, with high anxiety and stress levels. “They channel their emotions into their work and don’t want to deal with their personal lives—making more problems for themselves in the long run,” she says. “I have successfully encouraged them to take breaks for lunch, to walk—not sit—and to have a chance to be in natural surroundings even for five or 10 minutes on a regular basis. Problems will seem less urgent and much easier to deal with.”
Masini suggests acknowledging the problem and timeframe. “If you ignore this, you pass on your anxiety to the people you’re working with,” she says. “Make a decision on how to handle the problem—whether it’s canceling the rest of the day’s work, clearing an hour to deal with it or another means. Simply taking charge will alleviate some stress you have from wondering how to deal with it.”
Sharing Details with Staff
When telling a co-worker that you must take time off immediately to tend to a pressing matter, how much should you divulge?
“The degree of disclosure between the physician and staff member is generally dependent upon the relationship between the two individuals, as well as the nature of the difficulty,” Dr. Sansone says. “Closer work relationships may warrant a bit more disclosure, whereas sensitive problems may warrant a bit less disclosure. Most often, staff will not pressure the physician into disclosure; simply acknowledging that there is a personal problem is usually sufficient.”
Dr. Raymond notes that sharing feelings about an issue rather than the content of the issue has a calming effect. “Sharing negative feelings increases bonding, as well as a sense of camaraderie and safety,” she says. “It can make the doctor feel more supported. That takes the pressure off of having to pretend to be Superman or Superwoman.”
In particular, in Singer’s experience, some women doctors have felt pressure from women staff members to be their friends and confide in them. “Keep in mind that you can be friendly with anyone you supervise, but be careful about engaging in intimate conversations with them,” she says.
If someone at work pries about your personal life, Singer suggests you say, “Thanks for asking,” but be clear on your boundaries during the conversation. “If you wear issues on your sleeve, you’ll lose professional presence,” she says.
Dr. Chabra views his co-workers as his family outside of the home. “If your face shows that something isn’t right, you should acknowledge any inquiring staff member and thank him or her for having an interest in you,” he says. “However, it is not appropriate to share the full details [because] it may interfere with the relationship. It’s OK to answer in general terms, but be succinct. If it’s something you don’t want to share, simply acknowledge a colleague’s concern.”
‘If you wear issues on your sleeve, you’ll lose professional presence.’ —Donna Singer
Fielding Questions from Patients
So what if a patient asks the doctor how he or she is doing? How much information is appropriate to share in this scenario? Unlike work relationships, where there is more emotional balance in the relationship between the individuals, patient relationships are emotionally balanced toward the patient. “Most patients do not have deeply personal relationships with their physicians, so a brief, but polite, and vague response is usually sufficient (e.g., ‘I’ve seen sunnier days’),” Dr. Sansone says. “For patients who happen to be close friends or relatives (which are always more complicated relationships and not advised), a simple redirective response may be useful, such as, ‘Perhaps some day after work we can chat about this—it’s too much to go into now.’”
Regardless of your relationship to the patient, your body language, tone of voice and eye contact all have to say, “Thank you for asking.” Then provide a simple answer, and turn the conversation to the patient’s needs, but don’t convey avoidance or annoyance. “It’s not a bad thing for a patient to feel that the physician is human,” Singer says. “To be completely distant will be off-putting.”
Another scenario that may arise between doctor and patient is the doctor treating a patient with a condition the doctor has personal experience with. “I think it’s up to the doctor on whether to mention this if it might have benefit for the patient,” Singer says. “But don’t complain. A patient’s visit is not supposed to be therapy for you.”
Dr. Chabra believes rheumatologists have a unique relationship with patients they treat as a result of their chronic conditions. “We see them often, walk through trials and tribulations with them, and get to know them sometimes as well as a primary care physician,” he says. “Patients realize we are human beings and have obligations outside of the clinic. In the community, we may be in similar circles such as having children on the same sports team, attending the same church or sharing a common hobby.”
If a rheumatologist has to reschedule a patient’s appointment, Dr. Chabra advises saying a simple “thank you” to the patient for changing their appointment during their visit. However, “sharing your personal medical history or medications may not be wise in this setting, nor is sharing personal problems in detail. Patients are here for us to help them, and we must keep their concerns first.”
When All Else Fails
If attempts to deal with a problem don’t work or your functionality at work is impaired, consider a leave of absence. “Take this time to process your feelings and deal with problems,” Masini says. Some situations [that] would induce this type of stress are divorce, death of a loved one, having a serious illness or having a loved one with a serious illness, or being in an accident. For some people, investing themselves in work is a way of healing. If you’re that type of person, don’t take away the opportunity to heal through work.
Although some situations are out of your control, prevention is an important key to emotional health, as is staving off serious problems. “Physicians need to develop and maintain a network of supportive relationships in their personal life; engage in ongoing stress management tools, such as regular exercise, Qigong, meditation, tai chi and/or creative hobbies (e.g., music, art); and be alert to or mindful of evolving negative emotions and conflicts (i.e., the concept of self-awareness and mindfulness),” Dr. Sansone says. “Emotional issues need to be dialogued as they develop, not bottled up until a crisis unfolds. And perhaps most importantly, the physician needs to confront his or her fear of counseling or medication and get help when it’s needed.”
Karen Appold is a medical writer based in Pennsylvania.
References
- Bosson JK, Johnson AB, Niederhoffer K, Swann WB. Interpersonal chemistry through negativity: Bonding by sharing negative attitudes about others. Personal Relationships. 2006 Jun;13(2):135–150.
- Lieberman MD, Eisenberger NI, Crockett MJ, et al. Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science. 2007;18(5):421–428.
