It is a fact of being a doctor these days – some of your patients will sometimes complain about you. Whereas the ‘complaint’ used to be the clinical problem that the patient brought to the surgery- it is now also something that some patients may brew up during a consultation, or else-insulted- leave your care with. The potential of complaint is a constant threat to the personal and working life of a doctor, no matter how justified its communication or substance, and no matter the competency, empathy or humility of the doctor concerned.
Whereas before, when a culture of blame and distrust was less prevalent in society, and when a doctor was usually held up as someone who it was understood could or would ‘above all do no harm’, complaining about care was hardly ever heard of, it is now very much part of the roadmap of giving and receiving medical care, especially if the patient is litigiously minded or unable or unwilling to gain satisfaction in any other way.
The MPS and MDU are increasingly busy conflict resolution organisations – their relationship with doctors is intimate and evermore important. The GMC is also nowadays very busy dealing with a burgeoning number of disciplinary complaints that previously might otherwise have been dealt with more locally, in days where, arguably, transparency was less valued, and where local teams of medical staff regulated themselves, in firms etc.
From any doctor’s perspective, receiving a complaint is very stressful. It often comes as a shock. If not a lengthy suspension, it may signal the start of a long period of enquiry, extra work and self-questioning heartache. It may even lead to criminal action or being struck off from an extremely hard won career. Often there is a series of psychological hurdles to get over if the doctor is to feel the same about herself and her work ever again. The time it takes to process complaints is one area which compounds the stress and this is currently being looked at by the GMC. Look at the GMC website for more information and to take a survey by 10/5/2015 about this.
Recently I heard a talk by a barrister who defends doctors which presented a very interesting picture of a medical profession who relies on the GMC in a time of highly defensive medical practice. The question she asked is a good one: it is about the nature of the ‘public interest’ in which this culture of exacting enquiry exists. Is the public really being best served by a complaints culture which defends itself to a highly shaming and blaming tabloid press, she asked. Perhaps it might be better if it moved towards defending itself to the public at large who really urgently need doctors to do their best, in difficult times and places?
No doctor wants to see poor practice and for there to be a regression to the times where patients felt they could only be grateful for care or where power dynamics were so unfairly stacked in favour of a self serving medical profession who could do no wrong, no matter what they did. But surely patients do not want doctors to be so stressed out that they cannot practice at all, or only practice highly defensively- for fear of not being able to try to do their very best.
Why then, should a doctor experience special stress?
image from a 18th century hatbox.
If we want to get a bit more enlightened about stress we will need to start with the ‘slippery slope’ of what stress might mean, and for now, perhaps we can agree that stress is experienced as either, or both, physical and psychological pain of some sort due to a problem adapting to what we have to cope with in life- both at work and in our personal lives. In any case, it is not an object which we have to remove- indeed, that would be a very simplistic framing of the topic. Rather I want to suggest it is more like a form of ‘event’.
Why a doctor may be especially prone to this sort of ‘event’- a way of perceiving an experience and of being- is my theme in this piece.
Looking at the special stress doctors face I think it is possible to divide the cause of potential stress into the following categories:
A. Due to his or her internal or personal characteristics:
This could be due to a subjective sense of:
1. a particular duty ( a responsibility more than average to do the ‘right thing’ out of principle, not just due to utilitarian goals)
2. perfectionism or control needs ( helping other humans in need in the best way possible may be construed as this)
3. naturally caring or emotionally sensitive personality – the way we are conditioned to react to others over the long term (this allows empathy which demands a propensity to identify somehow with another’s pain without losing compassion and perspective)
4. a vocational take on the role of the doctor (i.e.’I am never off duty- this is not just a job’ type cognitions and something about the indispensible self)
5. an ideal self ( this may be a ‘false self’ imposed by someone else or else a part of oneself that is innate or self-given- there is a conflict set up between the real and the unreal nature of what a person can identify with)
B.From an outside perspective, doctors face the following demands and conflicts:
1. limited resources and a desire to help optimally (dissonance results and is uncomfortable since the doctor cannot be good enough no matter how hard she tries or how good he is- tiredness and a feeling of unworthiness may result as a vicious cycle is created of expectation and failure)
2. never enough competency (no matter the training and skill base, there is always a person or condition they cannot cure or make better or understand with current models or theories)
3. anger, fear, threatening behaviour, disappointment and loss, as well as joy and relief, gratitude (boundaries of normal relations and emotional containment are breached through a medical role which sanctions being close to strong emotional reactions)
4. The person as a ‘natural kind’- the doctor and her patient are not robots ( artifical intelligence, system processes and virtual interfaces highlight the boundary between personal vulnerability and our efficiency demands- how much can we let the fragile person in to the equation at any level?)
5. Uncertainty – nature may not be predictable, and the same applies to people and teams, as well as managed systems. We live in times of black and white thinking – a culture of blame, a culture of control and , indeed, a culture of injustice. We talk less about the need for equanimity as may some Eastern cultures. Wellness is considered a luxury by many- preventative care may not observe the same traditions of the doctor patient that a doctor thinks she has signed up to- confidentiality and trust may become weakened.
I shall explore some of these issues later on. For now, …if you want help with stress, either on line or at my devon clinic contact me via http://www.jobowenhypnotherapy.co.uk.
I am an email away on firstname.lastname@example.org
This new blog is provided as part of my stress management consultancy (see http://www.jobowenhypnotherapy.co.uk for appointments on skype or phone for stress management help).
It aims to cover lots of thinking about how doctors experience stress and pragmatic solutions to enable them to find good stress in their working and personal lives- what a famous stress researcher Hans Selye has called ‘eustress’. It hopes to provide insight into the world of stress in medicine, and it seeks to provide a range of creative and stimulating ways in which doctors can destress- all in one place- this blog.
It will, over time, extend its reach to cover the world of the medical student, the wannabe doctor, and also the world of doctors who leave medicine for career breaks or retirement.
It may also help those who are close to doctors, as well as any who manage doctors or who are their patients.That, I suppose has the potential to cover everyone. However my primary intention is that it may help doctors themselves- a chance to dip into the practical areas of stress management, to self help, to get help and to gain a perspective on moving towards a more productive, healthy and happy life.
Being a doctor involves normal stress since doctors are, as we are so often reminded now, ‘only people’, yet it is surely important to recognise other stress too- the stress of being a doctor. This is a specific stress since the role of the doctor is unlike another. These two types of stress- the normal and the special- will be the subject of my blog – doctorgoodstress. I hope you find it useful and encouraging. I hope you will contribute your ideas and your feedback too.
For starters, if you are currently feeling a bit tense- you might like to look at a relaxation exercise on my therapy website called ‘relax now’- see http://www.jobowenhypnotherapy.co.uk where it offered free near the bottom of the menu.
Until next time, …better be! Jo