Coping Strategies of Selected Physicians

COPING STRATEGIES OF SELECTED PHYSICIANS ALAN C. MERMANN* The work doctors do is frequently stressful. Medical and surgical emergencies are commonplace in tertiary care centers where the status of patients is often tenuous. Pain, suffering, anxiety, and death are conditions of daily existence. Many physicians and surgeons persevere, often with humor and subtle wit, and devote their professional lives to healing, teaching, and learning. In the face of considerable adversity, they provide excellent care for their patients: compassionate, highly skilled, and readily available service. They are enthusiastic teachers: students and house staff commend them for their ability and willingness to transmit their knowledge and skill. Many of these physicians are doing difficult work in specialties where the rate of salvage of fully functioning persons is not high. Why do some doctors do so well? How can they work long hours at demanding work and thrive on the challenges presented by it? Are there costs and risks associated with this type of lifework that are not readily apparent but that are there nonetheless? In an attempt to document how some selected physicians and surgeons contend with the severe stresses of their work, I interviewed 23 members of the faculty at the Yale School of Medicine. These questions were asked and discussed in depth. 1.What inner resources are called upon in coping with professional and personal stress? What external relationships are available for consultation , conversation, and confession at times of failure, error, and doubt? 2.Are there activities, hobbies, or entertainments that offer significant assistance? 3.What philosophic or religious "cosmology" is employed to provide an overarching framework for comprehending the self, interrelationships with patients and society, and the duties due each? *Chaplain, School of Medicine, Yale University, 333 Cedar Street, P.O. Box 3333, New Haven, Connecticut 06510-8020.© 1990 by The University of Chicago. All rights reserved. 003 1-5982/90/3302-0670$01 .00 268 I Alan C. Mermann ¦ Coping Strategies Background: The Calling There is one characteristic of these physicians and surgeons that requires comment: a distinct and clear sense of being called to the profession . A recurring theme early in the interview hour was the conviction that medicine had been chosen as a career in response to an inner need to bë a doctor. If you don't get pleasure out of medicine, if you don't look on it as a calling, then you're in the wrong business; being a doctor is the highest calling, higher than the priesthood; to aspire to something like this is overwhelming. The time-honored role of the doctor—caring for the sick—is to be lived out if one is to be true to the calling to attend patients on their frightening journeys. A corollary to the sense of being called is the conviction that the work meets two qualifying criteria: 1. The chosen specialty is important for the health and the well-being of others. There is something extraordinarily gratifying in the kinds of messages that the patient sends, how much they appreciate what you're doing; I mean the patient is appreciative of the handling, of the time you commit. A surgeon noted that it's actually as if you're fixing something; something that doesn't work well at all, and you're going in there and make it better, and that's a very constructive thing. 2.The good physician is expected to be as accomplished as it is possible to be: one must be good at the work. I have a good sense of who I am and what I do. I have confidence in my ability; I am well trained and I care a lot about my patients and I spend a lot of time thinking about whether to do this or that. To do the bestjob I can, that's about all I can do. What might be read as inflation of the ego is revealed, rather, as assurance that the combination of education, training, academic environment , and dedication to the patient has provided the strengths needed for persistence and excellence in the work one is called to do. Background: Training and Commitment The choice of a specialty is definitive in...