By Andrew L. Parker, Ph.D.
Faculty and Staff Assistance Program
Just as the level and complexity of stressors affecting the practice of medicine have reached an unprecedented degree, physicians are being held accountable as never before for angry and disruptive behavior in the workplace. Among the stressors facing physicians today are increasing caseloads, regulatory restrictions, and hospital bureaucracies along with decreasing autonomy, and authority. At the same time — particularly under the impact of managed health care — physician’s incomes are decreasing as the cost of malpractice insurance (not to mention medical education itself) has been rising. The combination of these and other factors has made the practice of medicine more challenging, and more frustrating, than ever before — and many physicians have reacted to these frustrations with angry behavior that hospital administrators have begun to treat with increasing seriousness and even disciplinary sanctions (up to and including dismissal). The purpose of this article is to address the need of physicians in today’s medical care environment for effective ways of recognizing and coping with these stressors, and in particular for understanding and managing their anger.
There are several key points to understanding the phenomenon of anger and managing tendencies toward angry behavior:
- Anger is an emotion, and as such it is intimately involved in the body’s neurophysiologic functions — especially so-called “fight-or-flight” reactions, adrenaline release mechanisms, and the autonomic nervous system (particularly sympathetic arousal and “kindling” processes).
- Like all emotion, anger is a largely involuntary, subconsciously triggered reaction to how we are affected by internal and external stressors; the stressors that typically trigger anger as an emotional reaction are various forms of frustration (obstructions to our actions or efforts) and/or pressure (demands on our time and energy).
- Anger runs a wide spectrum from mild irritation and annoyance through resentment and exasperation to rage, wrath, and fury; by the same token, it can manifest in a wide range of behaviors including contentiousness, argument, and intimidation to hostility, belligerence and violence.
- As frustration and pressure are facts of life, so is the emotional reaction of anger; however, while angry emotions may be virtually inevitable, angry behavior is not; we must distinguish between the emotion and the behavior, and realize that we are always responsible for the behavior — it is a dangerous form of self-dishonesty to believe that "we can’t help it," i.e., that people, places and things "make us" behave angrily, or that our justifications for angry behavior somehow excuse it. Remember: it is angry and disruptive behavior that physicians are held accountable for, not their emotional reactions.
- Learn to recognize the "early warning signs" of anger, e.g., physical tension and physiological arousal, angry thoughts and feelings of resentment or injustice; once recognized, always acknowledge the anger to yourself and then re-focus your attention on the stressors (frustrations and pressures) that have triggered it.
- Some of the most effective anger management tools apply less during emotional outbursts than between them: making sure you have adequate rest, exercise and a balanced diet, regularly letting go of grudges and resentful thoughts toward others, recognizing the destructive impact of our angry behavior on others, making amends when it has harmed them, practicing mindfulness techniques, and making good use of a faculty mentor to talk over difficulties. Such practices reduce the frequency, duration, and intensity of angry outbursts and make them easier to recover from.
- During the "storms" of angry outbursts, simple is best: if you can, take a brief time out to cool down; even if you can’t, taking a minimum of 20 slow, deep breaths will both calm you physiologically and emotionally, as well as disrupt the cycle of reactivity that drives the anger, by taking your attention off what is distressing you and promoting self-awareness.
In summary, the principles of anger management are essentially simple, but not so easily practiced. Angry behavior provides a significant discharge of tension and release of adrenaline; it can literally become addictive. At bottom, anger is the most energetic emotion and in that sense angry behavior is just a form of misdirected energy. Before you allow that to happen, ask yourself: "What else could I be doing with all this energy?"
We at the Faculty and Staff Assistance Program can provide you with counseling services as well as referrals for therapists in the community. FSAP services are free and confidential and available for both personal and work-related issues. Please contact us at (415) 476-8279 or visit our Faculty and Staff Assistance Program service page for more information.