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Doctors Can Get Angry, Too

Discussion in 'General Discussion' started by The Good Doctor, Apr 3, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    A guest column by the American College of Physicians, exclusive to KevinMD.

    There is a tremendous amount of anger raging in our society today.

    The profound uncertainty posed by COVID-induced cataclysms and the cultural, civil, and political unrest we’ve experienced over the past year has significantly skewed our sense of normalcy and well-being. Thus, responding with anger to these rapidly evolving and unpredictable circumstances isn’t at all surprising.

    And although we frequently encounter this anger in our patients, as doctors we are not immune to this understandable response to the collective stress we’ve recently experienced; many of us also perceive a heightened level of anger in our physician colleagues. This anger seems to manifest itself in different ways, ranging from generalized irritability to actively lashing out at others both within and outside of medicine and, unfortunately, patients.

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    There are certainly things in medicine to be angry about, many of which predate our current disrupted times. The pre-pandemic issues that weighed so heavily on physicians, including the increasing corporatization of medicine, significant loss of control in the medical decision-making process, a distorted and unfair compensation system, the intrusion of the electronic health record into clinical practice, and clear threats to the integrity of the patient-doctor relationship not only persist but have been amplified as the pandemic and other recent events have further exposed the fragile foundation upon which our medical system is built.

    However, the pandemic has been particularly traumatic to the health professions, with implications that will likely persist long after the coronavirus is brought under control. The existential threat inherent to working in medicine during a global health crisis, coupled with experiencing widespread suffering and loss and the many other personal and professional stressors unique to health care workers have posed even greater challenges to physicians that have been added to those that existed prior to the pandemic. Therefore, it is not surprising that this cumulative level of stress and uncertainty may strain our ability as individuals to manage it.

    Interestingly, as physicians, we may be less equipped to handle this level of stress and our reaction to it than we may suppose. We know that the personalities of those who enter medicine are usually well-suited to tolerate uncertainty and maintain a position of strength in the face of adversity. And our personal and society’s expectations of physicians typically hold that we should be able to manage a tremendous amount of pressure as part of our daily work and do so with an unwavering degree of stability and equanimity. However, both of these factors belie the reality that even though we are physicians, we are still human and subject to the same emotions and moral distress our patients are experiencing. And similarly to our patients, we may also find ourselves responding with anger to our current circumstances.

    Anger is typically considered to be a secondary emotion, one that occurs to counter feelings of loss of control or powerlessness in the face of overwhelming personal stressors. And although anger can be an effective compensatory mechanism, it can also be extremely harmful to us individually and particularly to our relationships with others, including our health care colleagues and patients. Additionally, there is a well-known connection of anger with depression for which we are all at risk.

    It is interesting that when I talk with my colleagues about why they are angry, they frequently acknowledge the frustration and emotional distress they are experiencing and often regret their more visceral reaction, realizing that their response may have been misdirected and potentially harmful. And they often are greatly relieved by the person-to-person contact and of knowing that others are struggling to deal with the same issues affecting us all.

    This suggests that perhaps the best way to manage the multitude of emotions triggered by the pandemic and other recent events that may push us to respond with anger is through close personal contact with our fellow physicians and colleagues. By genuinely sharing the feelings we encounter as we work through the collective trauma we are experiencing and acknowledging that no one is alone in this situation, we can find more positive ways of managing the pressures and the resulting emotions that can lead to expressions of anger.

    The events of the past year have been tremendously disruptive for everyone. However, they also provide us with an opportunity to pause and reflect on our own ways of managing the stresses and strains of our everyday work as physicians, and reinforce the importance of human connection and mutual support in our lives.

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