The wisdom to know the difference

"Stress is unavoidable when physicians try to control the uncontrollable," says John-Henry Pfifferling, PhD, director of the Center for Professional Well-Being, in Durham, NC.

Uncontrollable factors in a physician’s life include:

• patients’ temperaments and personalities and their reactions (or the reactions of their relatives) to pain, grief, loss, and stress;

• their expectations which are not articulated;

• opinions of other health care professionals toward them;

• plaintiff’s attorney and arbitrators;

• uncommon, rare, and previously undescribed drug antagonisms;

• outcomes of unknown causalities including alternative medical interventions.

However, some things such as compliance with therapeutic regimens, treatment and outcome expectations, consistency in staff communications, and clarifying communications can be partially controlled, says Pfifferling.

Then, there are the behaviors that, with willingness, training, and resources, physicians can control, Pfifferling says. These include:

• maintaining eye contact with staff and patients;

• using cooperation and notification to respond to untoward events;

• responding to incidents promptly;

• keeping lucid chart notes;

• giving patients and family members lucid and understandable instructions and education;

• getting real informed consent;

• accessing medical records;

• respecting the rights, opinions, and values of the individual;

• maintaining proficiency;

• deferring and delegating.