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Lee A. Resnick, MD, FAAFP
Influenza is off to a fast start this year and volumes are ballooning. ‘Tis the season to be swamped in urgent care, and without a good approach, urgent care clinicians can quickly become overwhelmed, burned out, and irritable. Pile on the stress of the holidays and the demands of family and loved ones and you’ve got a recipe for disaster. Work-life balance is important for all of us, yet feels almost out of reach in a profession increasingly squeezed in a vice-grip of revenue and productivity demands. If we don’t find a pressure release valve, we risk an explosion of negative coping and behavior.
The impact of these compounding stressors is dramatic:

  1. Suicide rates for physicians are more than double that for the general population.
  2. Female physicians have a rate quadruple the general population.
  3. Substance abuse, depression, and divorce rates are all higher for physicians.

Experts have identified several traits of physicians that seem to set the stage for negative coping, including the very bravado and invincibility that seems necessary in order to become a physician in the first place. Female physicians are even more vulnerable, as they endure a “double whammy” of expectations about their roles at home and at work. Caring for patients all day can cause a sort of “care fatigue” that can be especially problematic for physician moms who are supposed to be “on” when their male counterparts are generally allowed to be “off.”
Perhaps, then, it is not surprising that a “sense of control over one’s life” has been identified as one of the most important feelings associated with self-reported “well-being.” It is also not surprising that physicians have unrealistic expectations internally and externally about being “in control.” Nothing is more burdensome than this responsibility and it permeates the life of a physician “on and off the court.” Control, therefore, is a double-edged sword for physicians, and without perspective, can slice deeply into positive coping and a rewarding life and career.

I would propose that the vast majority of a physician’s work-life, on an encounter to encounter basis, is out of our control. The health care economy is such that individual physicians have little to no control, and the regulatory and liability environment isn’t exactly physician-friendly either. Pile on unrealistic patient expectations and a 5-minute encounter and any naive effort to wrest back control is something between an “utter waste of time” and “playing with fire.” You see, we are setting ourselves up for failure if we hang on to our dreams of control, and our continued pursuit makes us angry, bitter, and embroiled in negative relationships. No one is impervious to the aftershocks and consequences and many will bring it home, turn to substances, or worse.

It may just be that the only healthy way to regain control is to give away a good chunk of it….for free. Control what you can easily control but donate the rest. For example, it can be terrifically liberating to share control with patients, engaging them in decision-making and parsing out some risk. It is even more of a relief to give yourself permission to actually, heaven forbid, let some chips fall where they may. You simply can’t account for every eventuality in this business, so why insist on trying? This is not to say that we should care less or avoid more, but without a realistic, more balanced approach, it’s a zero sum game anyway. And when you break out of the self-imposed confinement of control, the whole world opens up to you, the sun shines more brightly, and the anger recedes. You will quickly enlarge your capacity to forgive those who have wronged you and, perhaps, even yourself. Your patients, family, and friends will notice and you may just rediscover the joyfulness of a career in medicine.

The ‘Control’ Paradox

Lee A. Resnick, MD, FAAFP

Chief Medical and Operating Officer at WellStreet Urgent Care, Assistant Clinical Professor at Case Western Reserve University, Editor-In-Chief for The Journal of Urgent Care Medicine