Bioethics Discussion Blog: Physician Discomfort : Some Reasons Why They are Discomforted

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Sunday, April 16, 2006

Physician Discomfort : Some Reasons Why They are Discomforted

If anyone thinks that physicians have some quality of training or experience that prevents them from experiencing or reacting to emotional discomfort, that person is frankly mistaken. The importance of considering physician discomfort is that such a reaction to an incident or condition may lead to the affected physician's temporary impairment of the intellectual function and clinical reasoning. The subsequent behavior and actions may not be appropriate for proper medical care.

The origin of the discomfort may be from many causes. It can range from something as simple as poor scheduling of patients with the physician having to feel rushed to unexpected patient demands or sexually suggestive patient behavior or even dealing with patient’s discussion about what they saw on direct-to-consumer TV advertising. Such acts as being required to perform unfamiliar examinations may discomfort physicians. For a physician to do evaluations, such as disability exams, writing excuses for school, work or jury duty or writing for disabled parking permits are also discomforting since these are actions where there are patient pressures along with legal consequences for the physician which cannot be ignored.

Physician discomfort can involve dealing with families after the patient’s death or in dealing with medical standards that suggest termination of life-support but which is in conflict with the family’s demands to continue therapy or that the physician may feel personally responsible for a patient’s death by signing an order for termination. As mentioned in prior postings, physicians may feel discomfort in being involved in medical management of medical colleagues, other physicians or even nurses or other “very important persons”. Even responsibilities such as attention to the minor health matters of family members may progress to situations where further self-medical management may be discomforting to the physician.

And there are more. There is no doubt that the overarching fear of being involved in litigation with financial and other consequences or loss of license to practice associated with some alleged unprofessional behavior is common to most physicians. This leads to the well-known practice of “defensive medicine” in an attempt to prevent these occurrences and to ease the professional discomfort. Such medical practice can lead to treatment delays, medically unnecessary additional consultations, increased costs and unnecessary risks to the patients.

I hope to write additional posts about physician discomfort and present some references to other writings dealing with this topic. ..Maurice.

4 Comments:

At Monday, April 17, 2006 2:21:00 PM, Anonymous Moof said...

Dr. Bernstein - thank you for this post. You all have a very difficult road to walk. Sometimes I wonder why any of you chose to do so.

You've mentioned things in this post which had never crossed my mind. I would imagine that your profession might cause some rather awkward proplems with interpersonal relationships - but medically, and personally.

 
At Monday, April 17, 2006 2:53:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof, you "wonder why any of you chose to" take that walk into the profession of medicine. I will tell you one possible answer. Some medical students who don't have a physician as a father or mother and hasn't lived the profession with them, may really not realize what they are getting into when starting to walk on that road. Students enter medical school altruistic and conscientious and have great desire to be of service to their fellow man.. but they will not learn the facts of the profession until they start on the hospital wards in the third year and then go on to their graduate training and into their offices. Once the facts of life as a doctor are fully known.. well.. they spent maybe 7 or more years in training and used up a whole lot of their savings and borrowing to accomplish that. So they see the parts of the profession which give them discomfort but they also see the parts that make them feel like a "mench" and something special to society and so now it is too late to quit and try some other profession. So they clench their teeth and continue onward with that walk.

There is no doubt that physicians get into awkward problems with interpersonal relations with patients, families and the physicians' colleagues. It is due to the fact that medicine involves a certain intimacy that a plumber doesn't have to deal with.. well, except for his/her relationship to toilets. ..Maurice.

 
At Monday, April 17, 2006 6:34:00 PM, Anonymous Moof said...

Dr. Bernstein ... I'm not sure if it's OK to ask you this on your blog, but it's apropos at the moment ...

"[...] and so now it is too late to quit and try some other profession. So they clench their teeth and continue onward with that walk."

Did you ever regret chosing medicine?

 
At Monday, April 17, 2006 9:36:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof, no regrets. Medicine and ethics and facilitating medical student education is all I know. I am not competent to do anything else. Actually, I don't want you or the other visitors to think that physician discomfort takes away all the pleasures and interests of being a physician. I think most physicians realize it comes with the territory and except for a few who do get "burned out", the majority continue until they retire, if they ever really retire. ..Maurice.

 

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