Qualidade de vida do médico

Are Doctors Happy ?

Shelly M. Reese

Introduction

Like medicine, happiness takes practice. But when it comes to happiness, some say the deck is stacked against doctors.

While physicians can legitimately point to any number of concrete problems putting the kibosh on their joy, some of their problems may lay a whole lot closer to home.

"Nobody is saying there aren't happy doctors out there," says psychotherapist Richard O'Connor, author of Happy at Last: The Thinking Person's Guide to Finding Joy. "Of course there are." But doctors may be more vulnerable to unhappiness than people in other fields, he says. That's because the qualities it takes to earn a medical degree are the very ones that can impede happiness. Combine these characteristics with intense training, isolation, and a stressful work environment and the resulting day at the office can be anything but sunny.

The Physician Personality

First, let's be clear. Doctors aren't the only ones struggling to find happiness. In fact, when it comes to workplace frustration, they're in good company these days. Thanks to corporate downsizing, workloads are heavier and morale lower in offices and plants around the country. Still, with the national unemployment rate hovering around 8.6%, "in most fields just having a job makes you happy with your job," says Tommy Bohannon, a divisional vice president at Merritt Hawkins.

But medicine isn't most fields. Left unchecked, physician unhappiness can lead to major problems, including disruptive behavior, burnout, medical errors, health problems, addiction, depression, and failed relationships. It can also induce doctors to leave the clinical arena: 40% of physicians responding to a 2010 Merritt Hawkins survey sponsored by the Physicians Foundation say they plan to drop out of patient care in the next 1-3 years.

Second, it's important to note that human beings are not hardwired for happiness. As O'Connor notes, "The cavemen who liked to linger contentedly around the fire were more likely to get eaten by the bears, and thus were not available to be our ancestors. Instead, those who survived to be our ancestors were alert, competitive, never satisfied, always on the move -- and we've got their genes."

That's especially true of doctors, and other high-achieving professionals. It takes ambition, perfectionism and drive to make it into -- and out of -- medical school and while those qualities may be very useful for achieving goals, they don't tend to foster happiness and satisfaction.

Being a doctor also calls for critical thinking and a degree of pessimism, O'Connor says: doctors aren't trained to look at the sunny side of life. They look for what's wrong with a patient, not what's right.

While the people who choose to become doctors may have an abundance of these qualities, "Medical training sharpens them to a needle point," he says. The result: physicians often graduate from medical school with a degree, a tendency to be brutally hard on themselves, and a profound inability to relax.

An Unforgiving Work Environment

Transporting this Type-A personality into a workplace fraught with life-and-death decisions, litigious patients, reems of paperwork, constantly evolving technology, long hours, severe time constraints, and shifting reimbursement models simply turns up the heat.

Added to those more obvious stressors is a profound sense of isolation, says Michelle Mudge-Riley, DO, founder and president of Physicians Helping Physicians, a consultancy that helps doctors transition to non-clinical or non-medical careers.

"Becoming a doctor is such a focused, linear path that you don't get exposed to too much else," she says. "The world is not just medicine and doctors can feel lost outside the medical setting."

That sense of isolation and unhappiness is particularly profound for late-career physicians, says Neelum Aggarwal, MD, a Chicago neurologist who frequently lectures on stress and burnout.

The career they signed on for -- the one that consisted of independent private practices and personal relationships with patients -- is on its way out, according to 89% of physicians responding to theMerritt Hawkins survey. While younger doctors may happily trade the autonomy of the old model for the work-life balance and financial security of the new employment-based model, older doctors feel the rules of the game have been changed on them. To make matters worse, many have been forced to delay their retirement due to shrinking portfolios, so they unhappily toil on.

Nearly two thirds (65%) of the 2400 physicians Merritt Hawkins surveyed said their attitude toward medicine was "somewhat" or "very" negative, a precipitous decline from the 49% who said they had negative perceptions before the passage of healthcare reform legislation.

"They still love the practice of medicine -- the actual treating and diagnosing of patients -- it's the landscape they have a problem with: the bureaucracy, paperwork and loss of autonomy," says Bohannon.

A Happiness Primer

So how's a doctor to find happiness? The same way everyone should, says O'Connor: work on it. Find a way to be happy in the now.

"The greatest myth of human life is the belief that I'll be happy if I just get what I want," says O'Connor. "All the research shows that as soon as we get what we want, we'll just want something else."

Instead, O'Connor counsels doctors to cultivate the essential relationships in their lives. Most people derive much of their joy and satisfaction from their family and friends: relationships that too often suffer in the face of 12-hour days and weekend call.

He also advises them to practice mindfulness, both through meditation and in their daily living. Mindful living is about taking a step back and seeing events in light of the bigger picture. The practice -- and it takes practice -- enables people to keep perspective so they can make wiser decisions based on rational thinking and intuition, rather than impulse.

But to be mindful people must learn to quiet their minds and settle down and that's something with which many doctors struggle. Dr. Aggarwal says she frequently challenges physicians to sit and do nothing for as long as they can. Few can sit still for more than a minute or two. Rather than relaxing, they try to "solve" their way through stress and burnout by doing more.

Goals Also Help

Having clear, achievable goals is important as well. For many doctors, graduating from medical school and getting into practice was a single-minded pursuit.

"Once you're in practice there is a tendency to get into reactive mode and it's at that point that I think a number of doctors leave the field," O'Connor says. "They need another goal to achieve."

Setting a goal doesn't mean earning a PhD or running a marathon, counsels Dr. Aggarwal. When she conducts workshops on stress and burnout, Dr. Aggarwal always asks participants what activities they enjoy most.

"The doctors who are doing well -- the ones who aren't in a burnout or stress cycle -- have an answer right off," she says. "You hear, 'I like to fish,' 'I love to camp,' 'I go bowling.' But the sad thing is many doctors don't have an answer."

It may sound trite, but for those doctors, finding a fun or fulfilling activity is itself an important goal. After all, their happiness depends on it.