Physicians children Never complain, never explain" By Jean Shaw Facets / May 1986 / United States Do Physicians make

good parents? Researchers who have studied medical families note that the relationship between physicians and their children is often strained, sometimes to the breaking point. John-Henry Pfifferling, PhD, founder and director of the Center for the Well-Being of Health Professionals, reports that the stress of parenting is one of the most common complaints received at the Center in Durham, N.C. Young interns as well as veteran physicians feel torn between their responsibilities at home and at the hospital, he says. Dr. Pfifferling notes that a chronic imbalance always exists between the time physicians devote to medicine and the time available to their families and to themselves. Unfortunately, we are conditioned, from the very beginning of our careers, to devote every ounce of effort and energy to our work, he says. That doesnt teach us much about learning how to carve out time for the people in our lives. As a young surgeion puts it, Medicine is an inflexible and demanding career. Whats worse, in terms of being a parent, is that most of us become inflexible and demanding people in the process of becoming physicians. Neither what we do nor who we are is amenable to a childs needs. How prevalent is a sense of neglect among the children of physicians? Roy Menninger, MD, president of the Menninger Foundation in Topeca, Kansas, believes that its widespread. I think that most of these kids are deeply ambivalent about their position. On the one hand, they may be pleased with the advantages that it brings them. On the other hand, however, they need, want and deserve more from the physician-parent more time, more attention, more concern than they are usually provided. My husband means well, says Elaine, the wife of an internist, but he cant come through for our children as a father because their activities and concerns are something that can be easily deferred. When push comes to shove, theyre the ones most likely to be shoved off of his schedule. Her oldest son agrees, adding, I really wish he was a regular dad. Elaine comments, When he does have time to spend with them, hes usually exhausted, at which point he tends to be argumentative and easily distracted. Those are the times that he orders them around and wont brook any dissension of discussion. And if hes not tired, then he feels so guilty about the whole thing that he goes overboard to make it perfect. At that point, we all feel like were on for a performance. Its very difficult to strike a normal, natural easy balance. David Briehaupt, MD, notes Most physicians only see their children when they are tense, tired , and irritable. Dr. Briehaupt, chairman of the California Medical Associations Committee on Physician Well-Being, adds, The exhausted parent is often then the hypercritical parent. And the exhausted physician parent may well expect his or her children nto behave like little patients and expect absolute compliance on all things.

The time pressures on physicians and their children bear striking resemblance to those faced by other professionals. Nonetheless, there are some important differences. As Dr. Pfifferling puts it, Unlike executives and other professionals, society expects physicians to have no other life but medicine. People will excuse an executive for taking time off to go to a ball game with his son, but not a doctor, who is expected to sacrifice everything for his patients. Dr. Menninger notes, We need to truly consider what the entire ethic that underlies medical practice does to our children. They are, too often, left with the overwhelming sense of Im not as saintly as that, Im not as good as that, Im not as smart as that. They dont see out struggles with these questions, our sense of inadequacy. And they need to. They need to have a sense that their feelings are natural and that theyre not alone in this confusion. The mystique of medicine also constrains children by forcing them to observe the code of silence, Dr. Menninger says. Our children are not allowed to be normal children, to have normal problems, he says. Normal problems are seen as breaking the covenant. They get the message and they get it loud and clear that if they have problems, they had damn well better not complain, because there are people out there who are critically ill and who need that absent parent a whole lot more than they do. It takes away their normal rights to their own feelings, their sense of legitimacy. And it causes a lot of problems. Oh yes, the never complain, never explain bit, sighs Elaine. Never get into trouble, be eternally perfect for your friends, your neighbors, your community. So much is expected of them! She adds, Weve tried very hard to protect our kids from that, but its not easily done. I feel like my work as far as that goes is often undone by people. Teachers are the worst, I think, at least in my experience. According to Dr. Briehaupt, the social pressures in a small town can be devastating. "Smalltown pressures are absolutely lethal. What they say, what they do, what they buy, and even who they buy it from is fodder for comments. In an urban setting, that's lessened somewhat. You can get 'lost.' On practical terms, that means that you can go grocery shopping and not feel as thogh you are living in a fish-bowl." One way in which the physician's children are expected to achieve is academically. Grades are a common source of friction and tension, Dr. Pfifferling reports. "Look at it this way, most physicians got where they are because they got As. Bs and Cs are not acceptable." The battle over grades is often a not-so-subtle battle over the child's career choice. " 'Can they make it into medical school with these grades?' That's the big silent question," Dr. Briehaupt says. "I do think that the pressure over grades is not what it once was," he adds. "Nowadays, I meet docs and ask them how their kids are and they can say to me, while making eye contact, 'He's well and happy and is running a boutique.' " However, he admits, "Maybe I get that because these docs know my history as a strong advocate for the kids." Elaine's husband Ron says, "I try to tell the kids that they can whatever they want to do. But you'd be amazed where the pressure can come from -- neighbors, other docs. And I have to wonder about the power of my example. I mean, is this another 'Do what I say, not what I do' kind of thing?"

"There's another problem with this one," Dr. Briehaupt says, "and that's this: what happens when dad or mom is not happy at work, when they're disillusioned with medicine? Then the message is a negative one. For the kid, the problem with that is the guilt that comes with the territory. It's 'Pop is working so hard to put me through Stanford and he hates what he does.' That has perilous implications for that kid. Just try to imagine those pressures." Because some children feel neglected, they pressure their parents for money and possessions -- and guilt often pressures those parents to give in. Even more troubling is the unavoidable fact that many children of physicians have turned to drugs and alcohol as a means of escape. "In some cases," says Dr. Menninger, "these kids are only acting out the family's tensions. They are the family's escape valve -- and they get punished for it. Instead, they should be seen in the whole context of the family. You can't set up a saint vs. sinner thing with these kids. It doesn't solve the basic problems." Those who counsel physicians and their children believe that the use and abuse of alcohol and drugs among these children is under-reported, just as teh abuse of alcohol and drugs among physicians themselves tends to be neglected and overlooked. "It's all part of the code," Dr. Menninger says. "and kids are dying because of it." Is family life receiving a higher priority among medical professionals these days? Dr. Pfifferling says, "I do hear young MDs talking and worrying about the balance between their work and their personal lives. They very much want to achieve some sort of balance. Among other things, they've seen the mistakes of those who have gone before. And in all fairness, it's easier for them to discuss these issues now. There is greater support and acceptance among the profession for these issues -- though it's still a struggle," he says. Dorothy, the wife of a young surgeon, says "I feel so strongly about the issue of priorities. If it came down to time in the lab vs. a Saturday with the kids, I know I couldn't tolerate too many days in the lab. But I know that's because I spent my childhood without a father. I can't take that for granted, while Barry can." For his part, Barry says, "Those of us without kids are definitely casting more than a casual eye at our friends who do have children. There's a lot of concern over how to manage all of this. But one thing that I do know, more than anything, is that personal relationships are what keep us human, as physicians. I always come back to the basic fact that we're people first and MDs second." Still, he admits, "The practical issues are a challenge. How do you manage to support your female residents who get pregnant? What about maternity and paternity leave time? Personally, I think it's real important, but actually figuring out a way to make it happen for people will be a real tough one to negotiate." "You know, all of us have one eye looking back over our shoulder," he says, checking out the competition at our heels. And it's only getting worse. How do we then protect our personal lives and our family's sanity?" One physician who worked hard to establish a strong family life is Renata, a radiologist now in her 50s. She offers this memory. "There were those days when I'd pull the car into the garage and I'd be so tired that I could barely remember how I had managed to drive home. I'd

just be sagging, crawling out of the car and up to the door. And I would literally tell myself, now when you walk through that door, your kids are going to be waiting for Mommy, and they need you to be Mommy, so, dammit, smile." "It's very hard, " Renata admits, "but you've got to find your way through it. You've got to be responsible to your children, and do it no matter what it takes." Renata's son Jeff says that he and his siblings got their mother's message of love and concern. "I remember kids razzing me, saying things like, "You make your own sandwich for lunch?" It never bothered me -- actually, I figured that there was something wrong with someone who couldn't find their way around a peanut butter-and-jelly sandwich." Jeff adds, "The main thing was that I knew when Mom came home, she would really listen to us. Both of our parents were real busy, but they made it real clear that if we needed them, they would com through for us. We always knew how much we mattered to them." "It's important to admit that we can't completely solve this whole issue," Dr. Menninger says. "Medicine makes extraordinary demands on all of us. But we do have to find some kind of peace with this, some balance -- for our own health, for our spouse's health, for the health of our children. Because as ti is, what our kids gain in independence and self-reliance and the whole raft of social and intellectual advantages is overshadowed by what they are forced to sacrifice in emotional well-being and inner stability." For those who would question Dr. Menninger, consider what Cynthia hast to say. "In my life, I've felt that I never had a father. He was a shadow man. Later, he recognized the problems and tried very hard to make for it all -- but you can only recapture so much." Her voice soft, Cynthia says, "Too much time goes by, it's too hard. There are those large chunks missing. And what makes me saddest is knowing that some of those missing chunks can never be put back. I love my father. I'm not sure, however, that I know him, or that he knows me. We're trying." Or, as Ron says, "I have a close friend whose dad was a physician and he was, and is, terribly bitter about it. I remember some of the things he would say. They were terrible. I know that I've got a lot of room to improve. Whenever I forget it, those memories come back to haunt me. After all, things are pretty basic, aren't' they -- we love our kids, we want the best for them. We want them to love us. We want our families to be happy. Why not do whatever we can to make it work?" Jean Shaw is a freelance writer in San Francisco, CA.