Tuesday, 25 September 2012

Doctors who view the practice of medicine as a calling are more satisfied

They feel better about caring for patients with complex conditions such as obesity and alcohol addiction than other physicians, research shows.
By CAROLYNE KRUPA, amednews staff. Posted Sept. 10, 2012.

The reasons that drive doctors to practice medicine can have an impact on how satisfied they are caring for patients with challenging conditions, says an Archives of Internal Medicine research letter published online Aug. 27.

Researchers analyzed data from a national survey of 1,504 primary care physicians. They found that doctors who see medicine as a calling are more likely than other physicians to be satisfied treating patients who are obese or addicted to nicotine or alcohol.

Of the three conditions, physicians were most satisfied treating nicotine dependence (62%), followed by obesity (57%) and alcoholism (50%).

Physicians who are unhappy with their career choice are less likely to be satisfied treating those disorders, and they often blame patients for their conditions.

The findings are significant given high rates of burnout in the profession, said study co-author John D. Yoon, MD, an assistant professor in the University of Chicago’s Section of Hospital Medicine and associate faculty member at the MacLean Center for Clinical Medical Ethics.

Nearly half of all physicians have symptoms of burnout, such as emotional exhaustion and depersonalization, according to an Archives of Internal Medicinestudy published online Aug. 20.

“For physicians, it may be that having a sense of calling to pursue personally fulfilling or socially significant work provides a strong enough motivator to persevere even in the face of challenges that can lead to burnout and job dissatisfaction,” Dr. Yoon said.

Handling complex conditions

Although studies have shown that primary care physicians can have a positive impact for patients with obesity, or alcohol or nicotine dependence, many doctors are wary of treating them, the study said. Such conditions can be frustrating for physicians because of the complex socio-behavioral components involved, Dr. Yoon said.

“They have picked three of the conditions most difficult to move the needle on,” said Fred Ralston Jr., past president of the American College of Physicians and a practicing internist in Fayetteville, Tenn. “Most doctors would say it is easier to lower blood pressure, cholesterol or treat simple diabetes, for example.”

Persuading patients to make meaningful changes in their lives can be difficult, he said. It often requires a patient having a significant life event — such as a heart attack — before they are motivated.

Dr. Ralston tries to get his patients to see the potential consequences of their lifestyle choices in advance. For example, he may tell a patient who smokes to imagine what it would be like to be diagnosed with lung cancer.

“I have learned to celebrate the rare, but significant, victories in these areas. It gives me support in continuing to work on patients who have not been successful,” he said.

Finding meaning in work

Physicians who have a sense of calling in their work tend to flourish more in their careers because they are working to achieve some kind of meaning and vocational fulfillment, Dr. Yoon said.

“Previous research in calling has found that those who view work as a calling are more engaged with their work, spend more time working and view the job as more central to their lives,” he said.

Dr. Ralston said he felt called to medicine to help treat patients in the community where his family has lived since the 1880s. Having long-term, meaningful relationships with patients makes a big difference. Physicians who are more satisfied in their careers will be sharper in dealing with any challenges, particularly difficult ones, he said.

“With the right frame of mind, it is easier to have realistic expectations when treating challenging conditions,” he said. “People skills are important in primary care medicine, and those who are happy are more likely, in my opinion, to put full effort into finding creative ways to improve outcomes.”

By contrast, physicians who are dissatisfied in their careers may become burned out, provide a lower quality of care, change careers or discourage prospective physicians from going into clinical practice, Dr. Yoon said. He hopes the study will lead to further research into how different specialties can cultivate a sense of calling in the practice of medicine.

“It seems to me that we need to begin addressing the intrinsic motivating factors behind physicians’ motivation to practice medicine in the long term,” Dr. Yoon said.

The above article originally appeared in American Medical News

Additional Reading:
“A Sense of Calling and Primary Care Physicians’ Satisfaction in Treating Smoking, Alcoholism and Obesity,” Archives of Internal Medicine, published online Aug. 27 (archinte.jamanetwork.com/article.aspx?doi=10.1001/archinternmed.2012.3269)

“Burnout and Satisfaction with Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population,” Archives of Internal Medicine, published online Aug. 20 (archinte.jamanetwork.com/article.aspx?doi=10.1001/archinternmed.2012.3199)

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