The personality characteristics chosen by and supported in medicine often conflict with family and self-care priorities. With the increasing complexity of a physician's clinical and administrative schedule, social and community obligations, as well as the spouse's and children's interests. are most likely to suffer. A family deserves planned blocks of time that are sacrosanct.

Specific hardships are associated with being in a relationship with a physician. Two-physician families are becoming more common, with their own specific pressures. Living with the persistent demands of medicine, most physician couples live for the future, convinced that eventually there will be time for each other. The couple unconsciously assumes that the delay will not endanger the quality of the relationship, and it will remain as fresh and intense as the day it was postponed.

Complex defense mechanisms, learned in the milieu of the emotional and physical fatigue of training and practice, frequently lead to a blunting of one's ability to respond to deep personal feelings. The most common complaint from physician families entering counseling is that the physician member is emotionally unreachable, if not physically absent.

Physicians become professionally comfortable being decisive and responsible. Rarely are the feelings or opinions of others welcomed—physicians merely give "orders." As experts, they know what is best for the patients. It becomes a common scenario to translate this to the home, expecting that problems will be solved by directive. The physician is tired, communication falters, and compromise is one sided as the family member decides to "let it go; at least he's [or she's] finally home." Arrogance is enabled. Conflict is postponed until crisis develops.

Spouses can benefit from a support organization. The aim is to assist in understanding medical stress, share coping mechanisms, reduce isolation, and understand their own role in the patterns that shape their intimate relationships. Serious consideration should be given to using a trained communication facilitator and formal group structure for spouses' groups.

Finally, if a physician provides medical treatment to his or her family, the care given can be unsuitable—either excessive or inadequate. A physician can not remain objective in assessing loved ones, and it is most often inappropriate to try. Both the physician and his or her family deserve as complete and thorough an evaluation as would be provided to patients arriving at their emergency department.

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