Family Medicine

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World Book of Family Medicine – European Edition 2015 One doctor described how good he felt when he examined a child who did not cry, even after forcing a wooden tongue depressor into his throat. He felt special pleasure in conquering his trust, and the trust of the child's parents accepting his explanations about him having "just" a viral infection. Other doctors described their satisfaction in caring for their dying patients and their families, discovering the real meaning of assistance when easing the physical pain of the body, or the emotional anguish in a cancer patient. They felt at their best in their ability to break bad news and to handle the anxiety and depression that followed. The emotional price paid by the doctor in his involvement gave him a feeling of spiritual uplifting. They felt that this was family medicine at its best. Many doctors shared the pleasure obtained through continuity of care, so characteristic of the profession, and the simple joy of knowing their patients. Powerful sources of pleasure were going out into the waiting room of the clinic, welcoming a patient-friend, calling him by his/her name, giving a strong and affectionate handshake, or a gentle touch on the shoulders while leading the patient from the waiting room to the examination room. Knowing precisely the appropriate opening phrase for each patient, from their last vacation to football, or directly addressing the patient’s suffering were also pointed out to be most satisfying. Physicians related to their feelings of affection that grew with time, while accompanying the personal, familial or health crises of their patients: “It’s the mutual respect, trust and friendship that develop over time that I especially enjoy.” The awareness that one has the ability to care and feel positive feelings, like a mother who discovers her ability to parent and love, was, in itself, gratifying to the participants. Contextual Gratification Many rural doctors live and work in the same community as their patients, or have personal friends as patients. Although this situation may cause problems, most of the doctors reported more satisfaction than problems. Some doctors reported their joy and pride at being invited to the weddings of their patients or being treated with a special respect by the community grocer or by the car mechanic. These satisfactions may have been unwarranted, yet the pride and respect doctors felt from their special status in the community were sources of special joy to them. With regard to the issue of professional status, the doctors, mainly the residents, reported that family doctors sometimes enter into competition with other profession specialists, wishing to win their collaboration and approval. While the disrespect some residents felt from hospital doctors was translated into indignation, earning the respect of colleagues was reported as a source of satisfaction. Hospital-based colleagues regarded the decision to become a family doctor as going down the easy path. Yet, most of the residents opted positively for a career in family medicine. Identifying and understanding the rewards and gratifications of their professional choice helped these family doctors overcome any insinuation that they took the easy option. Conclusion The joy we experience with our work radiates to the entire environment and to the patients in particular, fostering their well being and the well-being of the doctors as well. Pleasurable insights achieved in Balint groups or in workshops on the pleasures of doctoring can serve as another source of gratification and can help in preventing burnout. Take Home Messages Family physicians often deal with difficult patients, crowded waiting rooms, little time with patients and administrative pressures. Other pressures are related to the doctors' own personalities such as perfectionism, self criticism or fear of making mistakes. But, in every day of work of any family physician, there are plenty of pleasurable moments, laughter and intimacy. Three themes were identified regarding the pleasures of doctoring: professional, emotional and contextual gratifications. Pleasure in doctoring radiates to the entire environment, fostering both patients' and doctors' well-being. 122
Original Abstract World Book of Family Medicine – European Edition 2015 http://www.woncaeurope.org/content/451-pleasures-doctoring-family-medicine References Williams ES, Linzer M, Pathman DE, McMurray JE, Konrad TR. What do physicians want in their ideal job? J Med Pract Manage. 2003 Jan-Feb; 18(4):175-6. Brock CD, Johnson AH. Balint group observations: the white knight and other heroic physician roles. Fam Med. 1999 Jun; 31(6):404-8. Edwards N, Kornacki M J, Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ 2002; 324:835- 838 Balint M. The doctor, his patient and the illness. London, Pitman, 1957. Smith R. Why are doctors so unhappy? BMJ 2001; 322:1073-1074 Matalon A. The pleasures of doctoring as seen through reflections in Balint groups. Psychodinamische Psychotherapie 2010; 9: 176-182 (Ger) 123
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