Dear Beth

Family doctor's work stress

Dear Beth,...I am a family physician with a young family. My office is supposed to close at five most days, but typically I leave at about six-thirty, taking most of the charts to do at home. My wife works full time, and feels that she has all the responsibility for the children as well, because most of the time I am either working or exhausted.

One of the reasons for this is that I have a number of emotionally disturbed patients who are very insistent about telling me all their troubles. I have tried very hard to help, but after a few years of this it does not seem to be helping them, and it is incredibly draining as well as time-consuming. These patients stress my secretary and take up her time as well, which puts another strain on the office. I have tried to refer some of them to a psychiatrist, but they either refused to go or found fault with him and refused to go back. Whenever I have tried to cut down the time I spend with them they have got very upset and angry. I have already had disturbances in the office caused by of one of these patients, on one occasion because I felt I could not in good conscience prescribe the pain-killers that he wanted. Do you have any ideas about how I can get on top of the situation? I feel badly that the patience I used to have is wearing thin, because these people are obviously in great need, and it is not their fault that I cannot handle them.

Beth answers: It is not your fault either. Do not get sucked in by the popular myth of the god-like doctor. You cannot be all things to all people.

You do not have to put up with this situation. In my opinion it is a good thing that your patience is wearing thin--so long as you take action before you lose it. The bottom line is that you do not have to work with patients that you cannot handle. The first thing I would suggest you do is contact the Canadian Medical Protective Association at 1-800-267-6522 to find out the proper way to go about terminating with a patient.

Armed with that information, you can decide to let some or all of the problem patients go, and figure out under what conditions you would be able to work with any remaining. You can then offer the conditions and continue with those who accept, so long as they keep to the agreement. If this sounds too difficult, I would suggest that you get help with the details from a colleague who is especially good at managing patients of this type or a practical-minded psychotherapist. I have helped many people to do this sort of thing, and you might be surprised how much easier it can be with the right type of help.

I want to add that while some people benefit from having a shoulder to cry on once in a while, and then get on with their lives, the people you are having problems with seem to be the overly dependent type. Such people have a conscious or unconscious belief that they are powerless to solve their problems, and that their only option is to convince a more powerful or more capable person to do it for them. So long as they can maintain this fantasy, no change happens, except that they might get angry after a while because the helper is not performing as expected. It is usually very difficult to refer such people to someone who might really be able to help, because it would mean giving up the fantasy. However, if the magical helper steps out of the role there is at least a possibility that the person will at some point seek a psychotherapist and find one who has the specialized skills to be able to help.

All the best with it. There may indeed be people who cannot benefit from your time and attention, but your family certainly can!