In a recent article, Dr. Claire Gerada, from the National Health Service (NHS) program for physicians in the United Kingdom, reflected on the coping mechanisms that usually develop when practicing medicine and what benefits and difficulties they entail on a psychological level. The novelty of its approach is that it initially rescues the adaptive value of these strategies, to later point out when they can become problematic for the doctor.
The work of doctors has changed in recent decades and especially in recent years. The time devoted to bureaucratic and management tasks has increased, while investment in material resources and professionals has decreased. To this must be added faulty planning of the care offered. All these circumstances have contributed to increasing the exhaustion and demotivation of health professionals in general, and doctors in particular.
Beyond the new context in which practicing medicine, doctors live day by day, to a greater or lesser degree. With the suffering of the sick and, often, also of those close to them. Situations such as the communication of unpleasant news. The experience of traumatic experiences, the losses that the disease (and, ultimately, death) entails, can only be ensured if the doctor avoids emotional identification. With each case without losing empathy. Achieving that balance is not easy, and even more so if the conception of medicine as mere technoscience ends up being imposed. Ignoring the human aspects inherent in becoming ill that, whether present or not, come into play in the therapeutic relationship.
The doctor’s capacity for emotional self-containment is to be able to accept the discomfort of the subject. Who comes for help is gradually acquired throughout the professional practice. It is achieved through learning in which identification with other caregivers (teachers, mentors, colleagues, etc.). And the modeling that implies belonging to a group of equals prevails. Among the most common psychic defense mechanisms, altruism and sublimation stand out. But others such as humor, denial, projection, minimization, or rationalization of unpleasant emotions can also be activated.
These strategies, mostly unconscious, allow that coexistence with psychic pain does not end up overwhelming the doctor. However, sometimes these coping mechanisms (either by excess or by default) can work against the doctor as a person. Thus, excess altruism can lead to emotional exhaustion, when one’s own needs are ignored for the sake of attention to those of others. Denial can end up blocking self-awareness and emotional recognition; projection, by attributing weaknesses or mistakes to another, supports a sense of false invulnerability; while rationalization prevents familiarization and proper control of emotions.
When mental suffering leads to a mental disorder or an addiction, the feeling of personal vulnerability and incompetence in managing one’s own discomfort can lead the suffering doctor to deny his situation and delay the request for help. Hence the importance of gradually developing a culture, from undergraduate and throughout professional practice, that promotes, at a personal and institutional level, the development of competencies in managing one’s own and others’ emotions and asking for help when the coping mechanisms of falter.
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