Editor's Page

Do You Smell Smoke?


Fam Pract Manag. 1999 Jun;6(6):7.

Suppose for a moment that your diagnostic toolbox had one more tool in it — some kind of pyrometer designed for measuring emotional temperature, with dial markings ranging from “Life is cool” to “Warning! Burnout imminent” and a red zone way over at the right marked “Smoldering ashes.” What do you think your own reading would be?

If you'd expect your needle to be pointing toward the high side of the “Burnt toast” reading, you would hardly be alone. Family physicians are generally under enough pressure to raise their temperature. Add in the effect of friction from being rubbed the wrong way, and it's not surprising if you're beginning to smell smoke.

The factors combining to focus heat on you are not hard to identify. An article from a couple of issues back, “Turtles and Rabbits: Family Physicians Under Time Pressure” (April 1999) highlighted one of the major factors. The number and eloquence of the responses that article has elicited from readers is testimony to the size of the problem. (We plan to publish some of the responses in an upcoming issue, by the way.) And in this issue, “Putting ‘Life’ Back Into Your Professional Life,” by John-Henry Pfifferling, PhD, and Kay Gilley, MS, touches on several more.

One point Pfifferling and Gilley make struck me as particularly pertinent to the lives of many family physicians I talk with: “When your work environment requires you to behave in ways that conflict with your values, it's natural to feel stressed. And in the pressure cooker of modern medicine, it's easy to fall into a reactive mode. Instead of choosing how to act within our value systems, we tend to adapt to new rules, which may even directly conflict with our values.” And the situation is worse than they suggest, of course. Consider how far most of us are from having a single, coherent set of values. Practically every step you take as a physician sets some part of your value system jostling and banging and rasping against another part as your duty to your patient clashes with other duties — to family, to society, to an employer, to yourself and so on.

If you do feel your temperature rising, or if you notice smoke coming out of your ears more and more frequently, I think you'll be glad to see the advice that Pfifferling and Gilley offer. You'll also understand why FPM, ostensibly a practice management journal, devotes so much attention to life management. And, that reminds me, you'll be glad to see Balancing Act in every issue. It's our regular department covering life balance, stress, time management and the like. (Balancing Act is easy to find, since it's always the last department in the issue, within a page or two of the back cover.) This issue's installment taps the insight of Karl Singer, MD, a family physician I've known and respected for a dozen years — one whose emotional pyrometer needle always seems to be fully up against the stop at the healthy end of the scale and whose approach to life might help some of the rest of us retreat from burnout.

Robert Edsall is editor-in-chief of Family Practice Management.


Copyright © 1999 by the American Academy of Family Physicians.
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