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A 48-year-old specialist in gynaecology and obstetrics from a medium-sized town in Western Switzerland recalls how the stress of building up a practice almost tore her young family apart.

 
"As a young and relatively inexperienced mother, wife and doctor, raising a family while simultaneously building up my own practice soon changed from an exciting challenge to an exhausting nightmare. Yet if it's happening to yourself, you are often unable to identify the crux of the problem. Rather, at some point the relationship between my husband and myself reached such a destructive impasse that we both doubted at times whether we go on living together.
 
The conflicts began when our sons were two and four years old and I opened my first practice. My husband and I were both working long hours, so I decided to reduce my hours to 50 percent and engage a partner for my growing practice. The enormous stress led to a great many quarrels and hurtful arguments. Our situation at home gave us only limited opportunity to avoid each other, with the result that our interactions became ever more destructive. My husband was very hurt whenever my only response was to withdraw into myself.
 
At some point we decided to seek a marriage counsellor. I took a rather off-hand attitude to this step, thinking that it would certainly do him some good and would help us get on better. But after only two sessions I realised that I, too, was part of the problem. I decided to explore this in a separate counselling session, during the course of which it became clear to me that I had a difficult history with my own mother. This was why I was incapable of taking care of either myself or my husband and our relationship. And this in turn was impacting our life together: I was on the point of destroying my own marriage due to the challenge of balancing my work and my private life. I wanted to avoid this, yet at the same time felt I couldn't do it on my own.
 
I asked a friend and colleague, whom I trusted implicitly and who knew about our marriage difficulties, whether she could recommend a good psychiatrist. I then decided to refer myself, just like one of my own patients, and point out that that it was I who was seeking counselling. The fact that the psychiatrist responded to my referral with understanding and respect, professionally yet in a collegial manner, was the spur that made me decide I could rely on her. What also helped was the realisation that it is better to seek help rather than struggle on alone.
 

Had my friend not known of any psychiatrist or had I not known anyone who was already aware of my situation and whom I could trust, I would have been only too glad to get in touch with ReMed. With ReMed's help, I may have found alternatives to psychotherapy. At all events, it's good that doctors can count on ReMed's uncomplicated support whenever we reach our human limits."

 

 

The life partner of a 48 year-old doctor who died in tragic circumstances under the influence of drugs, tells the story:

 
I can’t shake off the doubts, they drive me mad: If I’d come home earlier I might have been able to prevent his death. Wanting to protect him was precisely the wrong thing to do; on the contrary, I should’ve risked everything to help him. If I’d known back then about ReMed I might have acted differently.
 
It all began about four years ago. My partner was more and more frequently not returning home after work at the hospital. I only became suspicious when I found some blood-stained clothing one day in the bathroom. He said this was a result of falling off his bicycle – but that couldn’t be right as he didn’t have the corresponding type of injuries. Then one day I surprised him on the sofa with a syringe in his arm, completely numb. Against his wishes I called the ambulance but he was able to convince the paramedics that he had everything under control and they left. He promised me that he would do more to balance his life out and for a while he actually became better again. However the number of incidents started to accumulate later on, and he was summarily dismissed from his job.
 
He again promised to improve and for a while he also seemed to be over the hump. He voluntarily attended a psychiatric clinic, agreed to treatment in order to overcome his addiction and took on a number of locum jobs. However, this was soon followed by relapses: loss of his driving licence, reminders through the post, being picked up by the police. Although binding agreements were made, he succeeded in getting out of them – he convinced the specialists that there was no problem. I kept silent for fear of doing anything that might harm him. This fatal fear prevented me from questioning and intervening. And even when I succeeded in overcoming this fear from time to time I was unable to get him to do anything about it: I couldn’t counter his expertise. Despite this, I wasn’t persistent enough perhaps, I should have simply pressed on – or referred him to a specialist agency such as ReMed if I’d known about it earlier.

 

When I subsequently fell very ill myself he gave me loving support and encouraged me to deal with the treatment ahead. His own addiction seemed to have disappeared and things between us were better than ever before. After I had slightly recovered, he fell back into a hole and became withdrawn. Nevertheless, we decided to go jointly for psychotherapy so we could learn how to deal with my illness. I attended the corresponding appointment on my own. I told the therapist the whole story about my experiences with my partner’s addiction problems. Feeling stronger and emboldened I left this appointment to return home. It was now clear to me that things couldn’t go on this way and something had to happen. Unfortunately it was much too late. He died that same day …

 

A 50-year-old single-parent doctor working in a group practice talks about her experiences with ReMed:

 

A difficult private situation, compounded by a serious accident sustained by my daughter, threw me completely off-balance.I became depressed, had difficulty sleeping, and my private and professional appointments were in utter confusion.Suddenly, case histories could no longer be located and reports were left lying around.My finances were also derailed.

 

So I decided to contact ReMed.To my astonishment, someone simply listened to me and had time for me – that in itself was a relief.I felt that this colleague knew what I was talking about and that I didn't need to explain my situation to him at any length.It was a great help to sort out the facts with him and set clear priorities.

 

My counsellor showed me very clearly that I was juggling too many balls:"No-one can do that on their own!"I had to admit that I had reached the limit of my capacities.I was also made to realise that I did not work efficiently.Since then I have been taking anti-depressives and am treating my ADS again with a minimal dose of Ritalin.As a result, I no longer have any severe mood swings and can work in a more focussed manner.

 

The biggest changes are in the administration area:My daughter now takes care of the billing, so I no longer need to worry about them and my daughter earns money into the bargain. Now we are up to date with the billing, which of course has a positive effect on my liquidity. We have hired an intern (social assistant) in the practice, who helps us with time-consuming psycho-social problems and takes a great many administrative tasks off my hands.I also simplified the year-end accounting, which is now done by the accountant.And I now transfer data electronically.

 

My time is much better invested in billable activities, particularly consultations."Saving by working for free" is totally unproductive – efficiency suffers, and it only ends in exhaustion.I limit my phone calls much more consistently.I save time by sending information by e-mail.When I think how much time all this used to take!

 

My colleague's question"Where does your relationship fit into all this?" made me stop and think, and shortly afterwards spend a week by the sea with my boyfriend.Finally I was able to take some time off and forget about day-to-day worries!But I know there's still a lot to do.And I've noticed that I do things a lot differently since contacting ReMed:I'm on the right track.Obviously, I must remain alert and stick consistently to my new routine, otherwise I will inevitably revert to my old bad habits.

 

A 44-year old hospital doctor, married, three children, tells of the severe depression he went through.

 
«Depression struck me completely without warning, within a few days – I had never experienced anything like it. For two years I had been senior physician in the traumatology department of a fairly large hospital. I was working alone, without a senior physician, and with no assistants reporting directly to me – for 24 hours a day, without holidays. I did it out of a profound sense of responsibility; indeed, I was proud of coping with my work competently and conscientiously.
 
And then I suddenly felt absolutely wretched, in a way I can hardly describe. I withdrew into myself involuntarily: I lost eye contact with patients, wanted to get rid of them as quickly as possible – and this was reflected in my therapeutic decisions as well. Initially I thought my conduct was due to lack of sleep, but then I realised: this is something different, something serious. I immediately phoned a colleague I knew and agreed to meet him. But the meeting was no help to me – on the contrary, I felt he just did not see me as a patient.
 
My wife, on the other hand, reacted wonderfully: she realised immediately what was wrong, and telephoned my former boss. Without hesitation, he arranged for a senior physician to be appointed who, as my deputy, took some of the load off me. My former boss was an important support to me. He stood by me through the crisis, visited me regularly – and that was precisely what I needed at that time. I have still not yet recovered from my depression. But I now know that I can turn to ReMed at any time to call on further support.»
 

A young house physician was faced with a death which troubled him greatly. The memory of that night still provokes feelings of anxiety years later.

 
«I was on night duty with sole responsibility for 150 patients – the senior physician responsible had already left the hospital. Suddenly there was a call from the night duty office: a patient with a serious heart condition was lying motionless on the floor. I raced immediately to the hospital room. In spite of my haste, I was able only to confirm the patient’s death. In my dismay, feelings of guilt immediately arose. Had I missed something? Should I have had the patient monitored better? Had I made a mistake? I know, of course, that a patient in this critical condition may die, but this knowledge was absolutely useless to me at this time.
 
Next morning, I described the events in my report, and raised the question whether I had made a wrong decision. But my supervisor merely stated that such things just happen. I was never spoken to personally about the incident.
 
Since then I have felt wretched: I suffer from pangs of conscience and I doubt my own suitability as a doctor. I can no longer sleep at night, and am troubled during the day by difficulty concentrating and bouts of sweating – my confidence is completely undermined. I would have liked to quit the profession immediately.
 
Yet at the same time, I am furious that as a novice I should have been left alone in this way. In a situation of this sort, a doctor urgently needs support, with caring but clear leadership by his supervisor. An analysis of whether a mistake had been made would have eased my burden – even if it had turned out that I had assessed the situation wrongly. I would have had clarity and would have been able to learn from the incident. Doctors in such situations must have the opportunity to reappraise events. It would, of course, be helpful to have places of refuge in hospitals themselves. But it is particularly important also to have people to whom one can talk on the outside – such as ReMed provides now.»
 

A 59-year old family doctor with a group practice in a small town and the father of two grown-up children tells of his depression.

 
«It was a heavy blow: after 22 years of marriage, my wife told me that she loved another man and wanted a separation. I was plunged into a severe crisis. My profession was taking up a lot of my life, of course, but my wife had her own activities as well. Things had not been right with us for a long time, and now it was suddenly over.
 
Looking back, I know that we had become strangers. My wife accused me of not being there for her after her serious traffic accident – this was true, but I had not realised it at the time. The most painful thing was the reaction of our children. For weeks, they maintained a reproachful silence, and they still cannot understand us today. And that is in spite of us performing well as parents – as we still do, incidentally. The situation was intolerable: I moved out as quickly as I could and got a divorce.
 
So how did I find my way out of the crisis? Luckily I had no reservations about psychiatry. I had sought professional help once before – for quite mild depressive moods. So this time I went back to see the specialist who already knew me. And I told my practice colleagues straight away as well. They supported me without getting directly involved – and this was very helpful. Important support also came from my friends and the clear structure of my professional day.
 
I mastered my existential crisis in this way without my work as a family doctor suffering. I can only advise other colleagues affected to seek professional help quickly in such situations. Today they can also turn to ReMed, of course.»
 

A married family doctor experienced a severe depression at the age of 51. It is only now that he recognises that his own needs are also important.

 
«I suffered my first nervous breakdown as an assistant physician in Argentina: the distance from home and peak workloads of up to 108 hours a week could not fail to have an effect. At 40, I experienced a profound identity crisis: was this really all my life had to offer? My mountain practice plus the emergency intensive care service during the winter season?
 
I wanted to have more time for myself, bought a cello and started to practise. But at the same time I got into politics and took on a political office. My workload actually increased as a result – and six years later came my major depression: I started to yell at my patients for trivial reasons. The lonely nights on the mountain affected me badly. I missed my wife and children who were living in the valley. After emergency call-outs I could not get back to sleep at night: I was drinking more alcohol, smoking heavily and putting on a lot of weight. Finally, my heart also slipped out of gear: cardiac dysrhythmias. It finally came home to me: things could not go on like this!
 
I made radical changes to my daily schedule and paid attention to my own wellbeing: starting work later, engaging regularly in sport, eating healthily. Smoking and alcohol became things of the past. I then succeeded in selling my practices and moving back into the valley – with a part-time position in a group practice. I was soon feeling on top form again. If only I had taken my personal needs seriously when I was still a young doctor and been able to call on a support network like ReMed!»
 

A 45-year old family doctor with his own practice finds himself unexpectedly in a crisis.

 
«You’re not looking well», a patient said to me after greeting me, as if she had no worries of her own. And another patient looked for a new family doctor because it seemed to him that I was no longer up to the job. This is how obvious the crisis was in which I found myself a short while ago. What had happened? A trip to see a friend who had lost his wife in a traffic accident, and was now on his own with two small girls, upset me greatly. On a visit together to the museum, the crisis quite suddenly overwhelmed me: dyspnoea, palpitations, claustrophobia. I had to rush out of the building. My wife and my friend were just as perplexed as I was myself.
 
On returning home, I summoned the last of my energy to drag myself through consulting hours, meetings and my duties as district medical officer. As my sensitive female patient had noticed, faced with her illness I suffered a panic attack – and this was not the only problem. Within my family, I dodged all my obligations. I neglected friends, and the mere ringing of the telephone was enough to trigger palpitations and sweating attacks. The psychological strain was so great that I soon sought professional help.
 
The way out of the crisis was long and exhausting. I restructured my daily routine, gave up positions and created work-free intervals. I slowly learned that I am not indispensable and that I cannot meet all demands on my own. Ultimately, this crisis has had a positive effect on all aspects of my life, especially on my partners and family.»
 

A 55-year old family doctor, running a dual practice and working as resident doctor in a care home, tells of his personal experiences: in addition to major professional strain, he was also troubled by existential fears as the father of a patchwork family of eight.

 
«had been aware for a long time of increasing exhaustion: I put down books unread, became more forgetful, made mistakes and was also drinking more alcohol. Superficially, I was functioning well. But my practice assistant drew my attention to more and more lapses. This frightened me. And my identity as a doctor was damaged by the fact that my patients’ histories suddenly no longer interested me. As a father, I was also plagued by existential fears. I started speculating on the stock exchange, and monitoring exchange rates throughout the night became a compulsion.
 
The way out of the crisis was not easy. I realised that time out was needed – and that I needed professional help. I found it through my family doctor. My practice colleague took on my patients temporarily so that I once again had time for myself. Little by little I arrived at the decision to give up my family practice after 20 years to radically reduce my workload. I continued my work at the hospital because this is where I felt good: the working hours are clearly regulated, and working with young people is enriching. Nowadays I enjoy the time regained, and I am doing well. The crucial thing was that I admitted to myself that I was in crisis and also spoke about it within my quality circle.»
 

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