Oct 1999 Table of Contents

Balancing Act

Relighting Your Fire



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If you're asking yourself, “Is this all there is?” you're not alone.

Fam Pract Manag. 1999 Oct;6(9):60.

This content conforms to AAFP CME criteria. See FPM CME Quiz.

Bill, a 53-year-old family physician, came to see me recently. He had a successful career, wonderful children, a thriving second marriage, many interests outside of medicine and financial security. Nonetheless, he was acutely distressed. Over the years, he found medicine to be progressively less rewarding and, at times, even tedious. He was increasingly angry at his patients and expressed his anger in uncharacteristic outbursts directed at colleagues. The pressure to see more patients gave him less time to do what he truly enjoyed — teaching. He was frustrated, lacked tolerance and felt he was making poor medical decisions. “I'm not sharp,” he said.

Bill was experiencing burnout. It's not uncommon in physicians. Up to 40 percent face burnout at some time during their medical careers. It's characterized by emotional exhaustion, depersonalization and feelings of low personal accomplishment. Are any of the following feelings familiar to you?

  • Life is heavy.

  • The world is gray.

  • It's more difficult to give.

  • You're drained of emotional and physical energy.

  • You've begun to view your patients as objects, not people.

  • You feel overloaded and overwhelmed.

  • You ask yourself, “Is this all there is?”

Refocus your energies

Too many patients and too little time had left Bill feeling out of control, which was manifested in anger toward his patients. We all love control, but control is a myth. Saying that may seem passive, but it's actually quite freeing. It can be helpful to remind ourselves that we can't control our patients or managed care companies or even our co-workers. If we avoid the trap of trying to control what we can't, we'll be less frustrated and have more energy for the work that's gratifying to us.

Reconnect with the world

Bill had become isolated from important relationships and was feeling disconnected. People who are isolated are more likely to exhibit psychological distress, and physicians are no exception. Twenty-five percent of physicians have treated themselves with psychoactive drugs, and the suicide rate for physicians is approximately four times higher than for the general population.1 We have all heard that misery loves miserable company. The purpose of connecting to others is not to become miserable. It helps us release distressing affect, reframe our experience in an adaptive manner, and provides a chance to blend our affect with our intelligence. The insight we gain into others' experiences might also give us a different perspective on our own. Recognizing that other people have similar feelings helps destroy the myth of uniqueness; that is, the belief that we are the only person suffering this particular fate.

Connecting to others also creates the possibility of further developing a sense of self-efficacy. Self-efficacy is the belief that you have the ability to produce a desired effect or follow a desired course of action. If we lack a sense of self-efficacy, we are unlikely to initiate coping behavior and will have great difficulty sustaining our efforts in the face of adversity.

Achieving balance

Bill was wise enough to seek out people he trusted. In talking about his anger and frustration, it became more clear to him that his disappointment was not in his patients but, rather, in the realities of medical practice. He wanted more from medicine than medicine could give him at that stage of his career. Bill found relief by shifting his focus from “Why is practicing medicine so frustrating?” to “What can I do to give my life meaning?”

He took a vacation to think about what to do next (yes, his practice was intact when he got back). He started taking an acting class, a longtime passion, and began to pursue interests outside of medicine. He also reduced his clinical activities (even though it meant decreased income), and he continued his efforts to reconnect with his peers at regular round-table discussions. In doing so, Bill discovered not only balance, but also a renewed sense of purpose.

Gaining a renewed sense of purpose will be facilitated by adapting to the changing medical environment in ways that will sustain us. We can start by asking ourselves these questions and following the direction of our answers:

  • Why did I go into medicine?

  • What did I expect to find?

  • Are those expectations currently realistic?

  • What needs do I want met in my professional practice?

  • What can I do to better meet my needs?

Dr. Blackall is the director of psychological services at the Penn State Geisinger Health System's Pain Medicine and Palliative Care Section at the Hershey (Pa.) Medical Center. He is also an assistant professor of anesthesia and behavioral science at the Pennsylvania State University College of Medicine in Hershey.

1. Schwab JJ. How to avoid burnout in medical practice. J Ky Med Assoc. 1995;93(1):23–27.


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