218 Being a Doctor After Being a Patient
myself. Since then, it’s much more controlled. Instead of getting
into a real fight, if I see this coming, I will walk away, and come
back and discuss it when I feel better. I also take a beta-blocker. It
takes the edge off—as a placebo or not, it doesn’t matter. I rec-
ognized that a temper was unhealthy, and I modified it.
Frank still strove to balance his commitment against his reprioritized
values. He didn’t want to ‘‘die with my professional boots on,’’ but nev-
ertheless continued to work hard.
Still, many doctors wrestled with questions of how much, exactly, to
decrease their dedication, when to do so, and how to decide. Brian, the
internist with hepatitis C, lowered his zeal due not his illness per se, but
to the fact that he was passed over for a promotion as a result of his
diagnosis.
For all the work and time I put in the institution, I wasn’t chosen as
director—rewarded. It made me step back and say, I’m not going to
kill myself for stuff that’s basically temporary. I put my heart into
work, but if I don’t get it done, it’s not going to get done. I’ll do
it tomorrow. I’ll leave at five or six instead of eight.
Brian cut his hours to a small, but still significant, extent.
Burnout
The workaholism and intense dedication elicited by the profession also
reduced balance in these doctors’ lives, facilitating burnout—especially
when they were ill. Even before becoming sick, many physicians grappled
with burnout. Frequently these feelings now increased. Illness prompted
sadness and frustration. These doctors then had to figure out how to cope,
and generally felt they had to choose between acting strong (as doctors)
and emotional (as patients).
The profession offered an ostensible benefit in enabling members to
avoid personal social commitments, but a self-reinforcing cycle could then
ensue. Stuart, now teaching at the university, observed about colleagues,
‘‘They get too emotionally involved with patients, not allowing them-
selves enough free time to enjoy other things. Some doctors don’t have a
life.’’ Little variation in one’s job, and frustrations with patients, can fur-
ther contribute to this frustration (e.g., ‘‘giving the same spiel to every
patient, and they don’t listen’’). Ironically, some felt that an advantage of
managed care was to lessen such dangerously high commitment.