THE PRACTICE OF MEDICINE, for all the satisfactions and privileges it may offer, also carries certain distinctive liabilities: doctors have high rates of drug addiction and alcoholism, and they are three times more likely than average to take their own lives. While suicide has been found more prevalent in specialties requiring obsessive-compulsive traits, no correlation has been found, paradoxically, between suicides and job satisfaction. Surgeons, like psychiatrists, enjoy a high level of satisfaction in their work, but surgeons have low suicide rates while psychiatrists have the highest among MDs; physicians who work full time in hospitals express low levels of job satisfaction and have high suicide rates; while pediatricians score low in both categories.
The marriage statistics of physicians offer another anomaly: 90 percent are married, and while many say they are discontent with their spouses, the stability of doctors' marriages in the highest of any profession.
What all this means is open to interpretation, but it seems safe to conclude that being married to a doctor can present its difficulties. This will not be news to many doctors' spouses, of course, but now it is out in the open with two books -- the first to my knowledge on the subject. Carla Fine, the wife of a physician, has produced the more thoughtful and thorough work in Married to Medicine. Cynthia S. Smith, who publishes Medical/Mrs., a slick magazine for doctors' wives, covers much of the same ground in Doctors' Wives but with less success. Both books are constructed from hundreds of anecdotes gleaned in interviews and buttressed here and there by scientific data. Whatever the merit of the generalizations drawn by this method, there is much specific information here that will interest anyone who is closely related to, or contemplating becoming closely related to, a physician, as well as future doctors themselves."
The marriage partners, mostly women but also some men, describe a number of the funny things that happen: i.e., the tendency of some doctors to announce with a glower that they are suffering from some grave, probably fatal, disease -- and intend to do nothing whatever except let nature take its course. But most of what they report is far from amusing. A doctor's spouse who believes that medical training will be the tough part of their life together is likely to be mistaken. For most, certain specialty practices and administrative posts aside, medical training is exactly that: training for the life that will follow. The wife of a physician is likely to be the sole parent raising children and managing the home; she is also likely to spend much time on her own; and if she married expecting frequent companionship, she will probably be disappointed. "My idea of marriage," says the wife of an emergency room doctor, "meant sitting around the dinner table with my husband and children, talking about our days' activities. . . . Now, if Len makes it home for dinner more than five times a month, I consider it a miracle." She adds: "In order to survive without becoming bitter, I gradually made myself come to terms with the fact."
The bitterest pill to be swallowed by a doctor's spouse, as well as the children, is that medicine comes first, the family second. The sooner that is learned, advises an older wife, the happier you will be. No difficulty with homework, no school play, graduation ceremony or birthday will take precedence over a gravely ill patient. Says the daughter of a Miami surgeon interviewed by Fine: "I remember when my younger sister was 11, I caught her telephoning the hospital -- a real no-no in our household. The operator said that our father was in surgery and asked her for a message. She sobbed into the phone, "Tell my daddy that today's my birthday, and he promised to come home before I had to go to bed.'"
When the physician does come home, it may be with the expectation of special treatment: "I've been in the operating room all day and you want me to walk the dog?" In acute form, the "God complex" can lead the physician to become isolated from family members and unwilling or unable to make the emotional contributions necessary to healthy family life. Or it may just be that the doctor is overly tired. When her husband arrives home, says one woman, "It's as if he's all 'peopled out' and has no room to hear any additional complaints or give any further advice. The demands on a doctor's time are so overwhelming that he's like an orange whose juice has been squeezed all day long; the only part left for his family when he finally gets home are the few remaining pits!"
There is also a tendency, sensitively discussed by Smith, of physicians toward emotional reserve. This can be explained partly bo doctors' constant confrontation with suffering, partly by their personalities, and partly by the training most receive. Medical students tend to be "hardworking, precise and controlled" in the first place, since those are the qualities that gain them entrance to medical school. But those are also traits often associated with emotional reserve, which is further developed by medical training and its emphaisis on rationality rather than feelings. Medical training also leaves students little time or energy for outside interests, and for the experience that can help to develop an emotionally mature, well-rounded personality.
But perhaps the most interesting picture to emerge from Fine's book is of female physicians -- a small but growing group that now represents 10 percent of the physicians in this country. They earn only about half as much as their male colleagues; are much more likely to experience marital instability; and their suicide rate is twice as high as that of male physicians and four times higher than that of women in general. Female physicians who are also wives and mothers seem to experience the most difficulties. Trying to excel both at work and as homemakers, many, understandably, feel themselves being pulled in too many directions. In a study by Dr. Marilyn Heins, of Wayne State University Medical School, it was found that large members of these women (up to 80 percent) did all the cleaning, cooking and child care in their homes. Dr. Heins concluded they did this to "prove to themselves and to others that they are adequately fulfilling both their homemaker and professional roles." Few, she observed, seemed to recognize what a superhuman requirement that is!
Men married to physicians also appear to fare better than their female counterparts. Probably because unlike the majority of the doctors' wives surveyed, most of the doctors' husbands had demanding careers of their own; and while they took pride in the doctor's work, they were much less likely to indentify vicariously with their spouses than were doctors' wives. Nearly all of the wives who seemed content had established lives of their own and had achieved a balance between three very separate components of their marriages: her life, his life, and their life together.
Both of these books are marred by numerous sad stories from women who chose to live vicarious, subordinate existences -- who, as my mother used to say, made their beds and now don't much like lying in them. Just as some have chosen to bask in their husband's reflected glory, others of those interviewed have placed the blame for their own problems squarely on their doctor husband's shoulders. "Not only did my husband not say a word about my acting like any Forty-second Street junkie," complains one woman in Fine's book, "but he also continued to give me my pills and injections on a regular basis."
If there is a serious flaw in either of these books, it lies in Smith's over-zealousness in trying to prove that being married to a physician is "awful." At one point she carelessly reports that Lenore Hershey, editor of Ladies Home Journal, "considers her work less important that her [doctor] husband's." But what Mrs. Hershey actually says, as quoted by Smith, is, "No matter what so-called prominence I achieve, it can never be more important in the scheme of things than his work. When we go to medical conventions, I am Dr. Hershey's wife. When he comes to my meetings, he's Lenore Hershey's husband. We're both proud of each other!"
At the same time, it's hard to argue with Smith's point that a doctor's wife can have a hard time developing self-esteem. "The doctor deals directly with life and death," she remarks, "and that's a tough act to follow."