Response: “Four-Thirty on a Friday”

Introduction

Famed medical author and surgeon Atul Gawande often shares his opinion of what would make medicine, an endeavor in which failure is “so easy, so effortless” (Gawande, 2007, p.4) better. He aptly identifies many of the challenges providers encounter: daunting expectations, the need to cope with illness and allow people to “lead a life as long and free of frailty as science will allow” (p. 5). The amount of information medical professions must learn is both vast and incomplete, their profession rife with uncertainty and ambiguity. The expectation is that they do their work “humanely, with gentleness and concern” (p. 5). It is no wonder those in the medical profession suffer from burnout, fatigue and depression. It would be easy to become pessimistic, jaded, and disconnected. Not only do patients expect perfection from medical providers, but physicians hold similarly high standards for themselves and their colleagues: almost all new resident physicians expect that they will never make a medical mistake during the course of their long career (Noland & Carl, 2006), yet most do. A study found that 84.3% of medical doctors in England made a medical mistake, with devastating results for both patient and provider. The providers experienced increases in stress, anxiety, sleep disturbance, and lower professional confidence. Most became anxious about the potential for future errors. Society holds physicians to a high standard of perfection, both professionally and physically. There is no room for error in medicine.

Dress to Impress

The high standards we hold physicians to include their personal appearance. Professional appearance is of the utmost importance. A highly publicized study found that what medical doctors wear may matter more than what doctors (and even patients) might think (Petrilli et al., 2018). In this study, just over half of the 4,062 patients surveyed in the clinics and hospitals of 10 major medical centers said that what physicians wear is important to them — and more than one-third said it influences their satisfaction with their care. They rated the providers on how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the attire made the patient feel. The majority of respondents favored formal attire with a white coat, followed by scrubs with a white coat, and formal attire without a white coat.

Achieving a professional appearance is taught in medical school and supervised closely during physician’s internships and residential training. What physicians wear is important to patients, influencing not only their satisfaction with their doctor, but their perceptions of competence.

Being a Doctor is Stressful

Job satisfaction is defined as “a pleasurable or positive emotional state from the appraisal of one’s job or job experiences” (Locke, 1976, p. 1304). There are three main appraisals that people make when evaluating their jobs: cognitive (evaluative), affective (or emotional), and behavioral (Hulin & Judge, 2003). Sadly, most doctors report low levels of job satisfaction and happiness with their work. In Sandeep Jauhar’s “Doctored,” he reports that only 6 percent of doctors are happy with their jobs and they commit suicide at twice the rate of the general population. Over half are unsure they would recommend the practice of medicine to young people. More concerning than a lack of happiness is physician burnout. Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job. It is defined by the three dimensions of exhaustion, cynicism, and inefficacy (Maslach, 2001). According to the Centers for Disease Control and Prevention (2008), a significant correlation exists between exposure to occupational stressors and the onset of various physical, emotional, and mental health problems—all of which can affect quality of life, provider productivity, quality of interpersonal communication, and may lead to professional burnout. Keidel (2016) views burnout as a syndrome that includes physical exhaustion, a negative job attitude and negative self-concept, and a general loss of concern for patients or clients. The provider who is experiencing burnout may feel more tired than usual and low in personal energy.