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INTRODUCTION

image CASE ILLUSTRATION

Don, a 38-year-old primary care physician, sighs as he sees Mrs. D.’s name as a last-minute addition to his patient list. It is mid-afternoon on Friday, and he had blocked out the last hour of the day to attend his son’s final softball game of the season. “Of all the days for one of her ‘crying headaches,’ “Don mutters to himself, “why today?”

Don’s skill in handling patients with somatoform problems is respected throughout the health center. Since he assumed responsibility for Mrs. D.’s care, her emergency-department visits have fallen by 90%, and she has even taken a part-time job. Don has almost always been able to help her through these spells by sitting with her, holding her hands, and letting her talk.

When he was growing up, Don was always a leader. In the Boy Scouts, his college newspaper, student service projects in medical school, he was always the one who could organize everyone and get things done. People came to depend on him for that, and while he never showed it outwardly, his capacity to hold responsibility was a source of pride. “Hey, Don!” The greeting comes from Grace, one of Don’s partners, breezing toward the door with briefcase in hand. “What a great afternoon! My last patient just canceled … I’m going to go home, pour myself a glass of white wine, sit out on the deck, and catch up on some journals. Hope you have a great weekend!”

The door opens, the door closes, and frustration, sadness, loneliness, and anger come together as Don watches Grace leave.

Primary care practice can be both an enriching source of personal growth and meaning and an unmerciful and depleting taskmaster. It provides us with access to a broad range of human experience—an intimate view of the characters and stories of a thousand novels—and an opportunity to have our very presence matter to others. At the same time, it makes constant demands and surrounds us with perpetual uncertainty; it relentlessly confronts us with our limitations of time, energy, knowledge, and compassion. It is a job that is never done; at best, problems are stabilized until something else goes wrong.

The balance each of us strikes between our own enrichment and depletion is critical to our own physical, emotional, and spiritual health and to our ability to care for others. All too often, however, we lose sight of this balance. We become so outwardly focused, attending to clinical problem solving, that we do not tend to our own renewal. This lack of balance is not surprising, our education has taught us much more about how to care for others than how to care for ourselves. The socialization processes of medical school and residency have cultivated a variety of unrealistic self-expectations and attitudes, especially concerning control and self- sufficiency.

Over time, this imbalance can produce a vague but increasing sense of demoralization, in ...

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