to start us off. This is just something I was reading today, in between grading and having regularly-scheduled conniptions.
So I read this cute little piece in Nautilus by Clayton Dalton,
An Rx for Doctors, which explains some research laying out "a model of control dynamics" for doctors and Nautilus readers as a plane, instead of as a linear spectrum from "trying hard" to "giving up," and that this might make us all feel better given that the world is a scary place. So I looked at
Shapiro's original study* marrying this control dynamic stuff to the problem of doctors getting stressed out and, wow! The model seems kind of goofy to me but it describes some recognizable human situations, so, ok:
The positive modes of control are represented by the terms positive assertive and positive yielding. Positive assertive involves active, assertive ways of gaining or regaining control. Positive yielding involves letting go of active control efforts. This mode is distinct from helplessness or passivity and represents the capacity to accept and respond effectively to potentially stressful, yet largely uncontrollable circumstances. The two negative modes of control are identified as negative assertive and negative yielding. Negative assertive or overcontrol involves inappropriate or excessive efforts to gain control, particularly in situations that are outside of one's personal control. Negative yielding, or helplessness, involves giving up and resigned passivity.
But Shapiro et al's point appears to be that if the "control model" is your hammer, every single doctor is a nail you can hit firmly upon the head. I would have to know more about medical infighting to know how spicy this take is; my sense is that she and her team are using this model in order to make their points about medical education reform palatable to a decent publication, because their larger game is "remember how we did all that research that said that wellness was biopsychosocial but then we still hated feelings and were incapable as a profession of dealing with them" --
Suchman (2000) has suggested that medical culture in many ways prizes control over most other values. This is apparent in the emphasis medicine places on making accurate predictions and achieving desired outcomes, the hierarchical structure of relationships, and “cure” as the overriding criterion for clinical and personal success.
Suchman (2000) further suggested that given such unrealistic personal and institutional expectations of control, it is understandable that physicians would be motivated to try and limit the “territory” for which they are responsible (e.g., “the body”) and correspondingly less inclined to deal with other matters (e.g., emotions, thoughts) that they experience as less concrete, harder to observe and quantify, and more importantly less amenable or subject to control and prediction.
I found the description of how the control model predicts doctor response to patients to be particularly butthole-puckering:
When we use the lens of “control,” the ideal patient is one who agrees with the physician's diagnosis, accepts the physician's agenda, is willing to follow the physician's treatment plan, in general shares the physician's world view, and finally, is grateful for the physician's time and assistance (
Khalil, 2009). Such patients support the physician's feelings of being “in control” of the encounter and the relationship. However, certain patient behaviors may be more likely to elicit feelings of loss or lack of control for physicians. These include: (a) demanding that doctors “fix” the problem, despite the problem not necessarily being “fixable,” or insisting on inappropriate treatment (the “demanding” patient;
Strous, Ulman, & Kotner, 2006); (b) becoming overly dependent or reliant upon the practitioner (the “needy” patient); (c) failing to take personal responsibility for their own
health care choices; (d) communicating certain emotional states (e.g., anxiety, fear, anger,
depression) that the provider is either personally uncomfortable with or finds difficult to address; and (e) having multiple coexisting psychological and medical problems, none of which is easily remediable (predictive of “difficult” clinical interactions) (
Rosendal, Fink, Bro, & Olesen, 2005). Relationships with such patients tend to generate negative physician responses (e.g., anger, frustration, discomfort, blame, helplessness), which we relate to loss of control, responses that are likely to adversely affect patient care and create emotional distress in the physician.
I bet they do!
*Shapiro, J., Astin, J., Shapiro, S. L., Robitshek, D., & Shapiro, D. H. (2011). Coping with loss of control in the practice of medicine.
Families, Systems, & Health, 29(1), 15-28. If you'd like to read the whole thing but don't have access lmk.
