Separating work from home life makes for happier doctors

One tired early morning, during my residency, I had been up all night in the ICU with a sick patient.  Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about one of your patients.”

I understood what she meant. Sometimes I feel like my patients are like family. I want only the best for them.

Years later, I began my first job working in a small town. One of my first few patients Ms. Joinings, came in to see me. Whenever I saw her name on my clinic schedule I got nervous. She had every disease: heart disease, diabetes, COPD, kidney failure (and on dialysis). Basically, any simple problem could be life threatening for her. That day was no exception. According to her daughter, she was more confused.

“Dr. Mashaw,” she said with an underlying tone of anxiety, “She just isn’t acting like my Mom.”

Sometimes its easy, a patient like this can get a simple infection like a urinary tract infection and that can be the gist of it. You treat the infection and your done. To the patient, you look like Dr. House. Unfortunately, I checked for everything I could think of with Ms. Joinings and all her labs and tests were normal. I suggested that we admit her, observe her and run more tests.

The look on Ms. Joinings face was pure terror.

“There is no way I’m going to a hospital,” she said, as if I were suggesting we admit her to the funeral home.

I couldn’t blame her, she had been in and out of the hospital about 10 times in the previous four months. So we discussed her goals and decided that she go home and if she got worse she’d meet me in the emergency room.

I was worried about her. In my mind, she could crash at any moment. I had given her daughter my phone number but hadn’t really gotten any calls.

Several days later, it was the 4th of July. My family and I made our way down to town to watch the fireworks. My son grasped my hand and dragged me on. Like the Energizer Bunny, he was so excited that he couldn’t contain himself. We live in a small town and everyone was there.

About every fifth person was  someone I knew, and every tenth was a patient of mine. It was festive, along every house was a family picnicking in front, enjoying themselves. As I was dragged closer to where the fireworks would be, we walked by a front yard with a family relaxing. One of them was Ms. Joinings. She was sitting in her wheelchair smiling. If she was enjoying her family she must have been okay.

I didn’t have time to talk to her or her daughter. My son’s excitement was too strong. But we talked briefly.

“I guess you’re doing better,” I said with relief.

“I felt better when left the clinic,” Ms. Joinings said with a smile on her face.

To think, I stressed about her for several days after that visit. And then it hit me. Caring so much and spending so much time on my patients is a double-edged sword. You are doing the best for your patients but, for many of us, we get burned out fast. I couldn’t enjoy my time with my family because I was so occupied with my patients. I had to have resolution from a patient before I could enjoy a 4th of July celebration with my son.

Work needs to be work and home needs to be home. For me at least, there couldn’t be a grey area. So now, I don’t give out my phone number to patients and I force myself to let my colleagues cover for me when I’m not working. I’m not the “everything doctor” I had envisioned myself as, but it has made me a happier person in the end.

Arsheeya Mashaw is a geriatrician who blogs at A Doctors Guide to Healthy Aging.

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  • DoubtfulGuest

    An excellent caring doctor of mine got burned out and ultimately misdiagnosed me. I was harmed by this mistake. I’m working to understand all sides of the issue.

    A good reminder…you have a right to preventative self-care (i.e. you are also your own patient), and your own family and friends need you. It’s also best for your patients in the long run if you periodically recharge your batteries.

    • rbthe4th2

      I suggested this and got booted out of a practice. I did the same as you did. I think the lack of doctors working to prevent these types of things, just make the issue of business people overtaking their oversight so much more needed. Docs have blatantly been preventing oversight and allowing their own, who shouldn’t be, working. Until that is fixed, then docs get the lawsuits, the non positive reputations, the recriminations, until the cows come home.
      Work with us docs. Those of us who are trying to deal with things without lawsuits, if you worked with us, you might find life is better all around. Until then, the phrase is, you made your bed, now lie in it.

      • Suzi Q 38

        I agree.
        I am glad that two physicians and a PT provider stuck up for me. Without them, it could have been far worse.

      • DoubtfulGuest

        Exactly. Doctors, some of us really care about your stress and we want to change things for the better. So, how about not throwing us under the bus when you make mistakes that harm us? Let’s talk about solutions instead.

        rbthe4th2, the resistance is frustrating. Sorry you also had a bad experience. Over on the “patients defining an adverse event” thread there was a semi-productive discussion about reasonable expectations and appropriate boundary setting. However, I ended up feeling that I acknowledged doctors’ concerns as valid but the patient perspective was not really treated as valuable or insightful. Have to keep chipping away at it, I guess. Education goes both ways…

  • Suzi Q 38

    When my doctor finally was “called out” on his error with not diagnosing a serious condition of mine, he called me. A couple of colleagues had found out what was wrong with me, and they were not only surprised and angry with him, but concerned for me.

    My doctor finally found the time to call. I was so angry that I yelled at him on the phone. He took it like a “trouper.” He tried to apologize, but knew that he could not, due to the possible threat of litigation.

    What a frustrating place to be, if you are human and feel bad.

    He said that he was going home to his family and think about what I said.

    I told him that while that was admirable, he just needed to reflect about what had transpired, realize that patients are not always hypochondriacs. Some of us are educated and know when something is very wrong. We do not call or write to our physicians for nothing.

    I also told him that when he goes home, he should be at home. In other words, try to forget about patients and errors like me when he is “off the work clock”.
    He is allowed to think about patients again when he goes back to work on Monday or the next day. He wife and children deserve his attention when he gets home.

    A friend of mine is in her 30′s. She said that her dad is a physician, and she never felt that she ever had his attention at home. He was always thinking about his patients, even when they were on vacation.

    I know that we are important, but how sad.

    • rbthe4th2

      Moderation is a big key.

    • Guest

      To put it simply, easier said than done.

      • DoubtfulGuest

        Are you a doctor, Guest? If you did have time to explain some of the limitations, I bet people would like to be more aware. I know, for example, that the doctor who harmed me with the misdiagnosis is in a specialty area with a shortage of docs, at least in my part of the country.

        Many of us here are genuinely interested in the well-being of our physicians as well as ourselves.

        • Guest

          If anyone really cared about the well-being of physicians the system wouldn’t be the way it is. Not to mention that it will only get worse with Obamacare. Physicians are constantly overworked, sleep deprived, and generally unhealthy. Yet, this doesn’t affect insurance companies or anyone with a bird’s eye perspective. All I’m saying is there’s always a flip side to any coin and unfortunately errors are usually made because of the system itself moreso than the physician.

          • DoubtfulGuest

            I hear you. I think the problem is so few people have any idea what it’s like. Everyone is just feeling his/her part of the elephant (is that the metaphor?) and the right questions obviously weren’t being asked when our current system was developed. I respectfully disagree that many fully informed people would still not care.

            I do agree that many if not most errors are system errors and the doctor may be only part of that. What would you want any patient of yours to know, or do, to make things go as well as possible for both of you under all these external factors and constraints?

      • Suzi Q 38

        I will admit that. I haven’t “walked in your shoes” for a day.

    • Richard Willner

      A physician is not God. He makes his decisions based on all data and based on educated opinions. While his diagnosis is generally spot on, it is simply impossible to be 100% certain. Chewing out a doctor might feel good for the moment but only accelerates his retirement.

      • Suzi Q 38

        Thank you, you are right.
        I need to keep reminding myself of that.
        I am sure I will serve these doctors as a living reminder of what can go wrong if you ignore a patient when she asks for assistance.
        I know that I can push and punish, but would that make me feel any better in the end?

        • Richard Willner

          Suzi,

          If I read your last comment correctly, you said that you “can push and punish” I doctor because “he did not listen to me”.

          • Suzi Q 38

            Yes. A couple of doctors that did not act on my troubling nerve symptoms.
            I can complain now that the damage is done and the errors are apparent.
            It did feel good for the moment.

            To finally be believed is an amazingly freeing thing, even if it took a near loss of my walking mobility to finally prove it.

            I have already complained and the hospital officials are actually trying to defend their behavior, but I have too much proof in the way of emails, prescriptions, specialist visits and EMR records.

            I have realized from some of the articles on this blog that what happened to me is sadly commonplace. Here I took what happened to me so personally.

            Is my goal to punish a doctor so severely that he feels like retiring early? He was already very contrite when “called out.”

            His delay of care allowed the spinal stenosis in my c spine to permanently worsen my nerve condition in all 4 limbs, my bowel and urine function as well.

            I vowed that I would complain to the highest authority, but I notice that those groups don’t care either. This is why the Internet is a good forum to make that evaluation and announcement. “Buyer beware” will be my theme.

            Long story.

  • PollyPocket

    As a doctor’s kid, I’m glad for your family that you came to that conclusion when your son was still so young.

    It isn’t fair to kids to never be the most important person in their parents’ lives. When obligations are tossed aside because the pager is going off it send a message that the stranger on the other line is more important. When you aren’t allowed to contact your parent because he or she has clinic or a big surgery, it reinforces that message.

    To be a good parent, and to be fully present for your family, you absolutely need to have healthy boundaries, regardless of your chosen profession.

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