Psychology of Unhappy Doctors — unmet expectations

Doctors are unhappy because the medical world  is not what they expected (or dreamed about).

An essay in the Wall Street Journal today “Why Doctors Are Sick of Their Profession?” describes the feelings of many doctors.   What are those feelings?  What do they mean?

Most physicians cope very well and are quite successful in society.  Clearly, they do not have a psychiatric disorder as a group.  Yet, the WSJ article lists certain symptoms.  These are feelings of:

frustration, failed aspirations, malaise, worthless sacrifice, loss of control, conspiracy of lawmakers and insurance companies, devalued work, and recurrent intrusions of unpleasant thoughts.  Lawyers (the scum of the earth) make more money than they do.  And, oppression is keeping them from doing things the “right way”.

If a patient complains of those symptoms the diagnosis would be: depression with underlying obsessive-compulsive and narcissistic traits.  For doctors it may just be the world is not what they expected when they started 15 years of training.   The job is basically good and it’s too late to start over.

Is money an issue?   If a distraught patient says their anxiety has nothing to do with a “recent divorce” … it really has everything to do with the divorce.  If a doctor say it “has nothing to do with money” … it’s the money.

As a group doctors have a huge capacity for delayed gratification.  They go through difficult years of training by thinking it will get better later — the salary will go up, all the testing will stop, professors will go away, long hours will improve, and no one will question their decisions.  Welcome to the real world:  stagnant salaries, maintenance of certification tests, professors who set evidence based guidelines, long hours and insurance companies that question decisions.

Medical training is mostly to blame.  It’s too long, often unfocused, minimizes teamwork and shuns consistency.  The fight for doctors to follow evidence based guidelines is undermined by the constant drum beat of “cook book medicine”.  In fact, most medical treatment is by the book — a stunning revelation to most.  If physician expectations were better managed during training the dissatisfaction after training would not be an issue.

Many employees find their job the least stressful part of the day.  Stressed physicians need to focus on their job of diagnosis and treatment — it is very rewarding.  Extraneous worries can drive you crazy.

Accountable care organizations reduce physician stress by focusing physicians on the job of taking care of patients while business professionals manage the business.  Perhaps increasing the structure of medical care is the solution for physicians, not the enemy.