1. Hearts and Bones Paul Simon Medical Marriage making yours better Dr. Lil Miedzinski Dr. Vincent Hanlon

2. 1.877.767.4637

3. Physician Relationships

4. little to disclose

5. Learning Objectives ● Understand why physician relationships are at risk for difficulty. ● Recognize some of the warning signs of troubled relationships. ● Consider a few strategies that may improve the health of our relationships.

6. Is this topic worth an hour of our lives? for you your partner your relationship?

7. Gratitude

8. In our intimate relationships Recall one characteristic that you value about your partner/spouse/good friend In one word Got an example of that characteristic?

9. Intimacy affection, companionship trusting each other sexuality feeling honoured by our partner a sense of connection, feeling understood identifying as a couple autonomy within the relationship

10. Love is blind— marriage is the eye opener. Pauline Thomason

11. Marriages are made in heaven but lived on earth. George Herbert 1593-1633

12. ARLS Pretest Best predictor of a happy relationship: a. sex life b. kids [or no kids] c. postal code d. after tax income/average BMI e. other [see previous slide on intimacy]

13. ARLS Pretest Of all couples in Canada marrying in 1990, what proportion will divorce by 2020? a. 20% b. 30% c. 40% d. 75%

14. ARLS Pretest Of all couples in Canada marrying in 1990, what proportion will divorce by 2020? a. 20% b. 30% c. 40% d. 75%

15. ARLS Pretest Divorce rate among physicians is a. lower than the general population [gp] b. same as the gp c. 10-20% higher than the gp d. 20-30% higher than the gp

16. Marriages t Divorces

17. Why marriages breakup Falling out of love 27% Extramarital affair 25% Unreasonable behaviour 17% Mid-life crisis 10%

18. 1289 calls to PFSP in 2011

19. The legacy of medical education By omission and commission, the training of medical students and residents devalues emotion and the importance of love in the hearts of its students. Myers & Gabbard, 2008

20. What MDs bring to marriage compulsiveness perfectionism our way of doing things emotional detachment workaholism, “psychology of postponement” loss of playfulness/humour Sotile & Sotile, 2000

21. Common complaints of couples “Trouble communicating” Frequent arguments Role strain in female & male physicians Disagreements over children, parents Loss of intimacy (less frequently: sexual difficulties)

22. Common complaints of couples Verbal abuse (less frequently: physical violence) Infidelity Alcohol misuse Lack of time together Physical or psychiatric illness

23. Common complaints of couples Ethno-cultural issues of IMGs Intermarriage Second marriages & blended families Financial worries, status anxiety Retirement challenges Myers, M & Gabbard, G. 2008. The Physician as Patient.

24. Warning signs Bored or lonely? Not valued? Unresolved, recurring arguments? Silent resentment? Passive-aggressive behaviour? Indifference? More work, no play? No sex? More alcohol? Prefer to be somewhere else? [Myers, 2004]

25. Complicating Circumstances Working rural/lack of replacement coverage Working in especially demanding branches of medicine or practice situations Paying down debt/end of training feelings of entitlement Two or more families to support Extended families offshore Myers, 2001

26. The way ahead

27. Ain’t no cure for love.

28. John Gottman

29. What do we do? As individuals, as a profession Prevention, promotion, treatment

30. The profession As practitioners and teachers when and where do we devalue or honor our important relationships? Continue the health conversations hours of work, accommodations, protected time for family and partner, measures of success

31. The individual & the couple Allow ourselves to be cared for without needing to dictate or control that care. Practice ways to show up and pay attention to our relationships—daily conversation, vacation, dates, celebrations, marital enrichment.

32. What surprised me? What inspired me? What touched my heart? Rachel Remen

33. WAIT

35. Day by day Daily communications: BID Prepare and eat food together Set boundaries between work/not work

36. Day by day Be able to gear up and gear down Turn the techno-telecom down or off Respect partner’s time, activities, work

37. When the going gets tough Include FD for both physical and mental health issues (burnout, anxiety, depression, alcohol overuse). Seek professional help early [PFSP].

38. In our intimate relationships Recall one characteristic that you value about your partner/spouse/good friend Mention that to your partner—today

39. Resource list Gottman JM and DeClaire. 2001. The Relationship Cure. New York: Three Rivers Press. See also http://www.gottman.com.http://www.gottman.com Balancing your life at work and home. 2009. American Society of Clinical Oncology. jop.ascopubs.org. 253-255. Maier, DB. 2007. Get early assistance for relationship challenges. Alberta Doctors’ Digest. Sept/Oct. Available at http://www.albertadoctors.org under PFSP Resources for Physician Health.http://www.albertadoctors.org Munro, Alice. 2009. My Best Stories. Toronto: Penguin. Hill, Monica. 2011. Relationships: What works for physicians? Alberta Doctors’ Digest. March/Apr. Available at http://www.albertadoctors.org under PFSP Resources for Physician Health.http://www.albertadoctors.org Myers, MF. 2001. The well-being of physician relationships. Western Journal of Medicine. 174: 30-3. Sotile, WM and Sotile, MO. 2000. The Medical Marriage. Chicago: American Medical Association.

40. The Unexpected Benefits of Showing Up Organic Dark Chocolate with Crystallized Ginger Pieces Original Daylilies postcard—free delivery worldwide The Relationship Cure by John Gottman + OMA Micro-mints Rwanda Cafe Feminino The Guardian Weekly The Progress of Love by Alice Munro Evaluations please The Winner kd lang

41. Whose Gonna Miss You? Danny Michel

42. Career Ecosystem Personal Professional Organizational Taken from G. Hirsch, MD

43. Title ● Text

44. General Principles Attend to our relationships find ways to “show up” how do we support each other Practice incremental change Go where the meaning is

45. Life changing Reinvent the body Resurrect the soul Ultimate happiness 7 keys to joy plus MUCH MORE!

46. People are anxious to save up financial means for old age; they should also be anxious to prepare a spiritual means for old age. Wisdom, maturity, tranquility do not come all of a sudden when we retire. Abraham Joshua Heschel