I don’t think I’ve ever written that much about the workplace in the field of medicine. It’s something that has always bothered me at some level but I’ve come to accept as an inevitable evil that could not be changed.

In medicine, everybody is your boss. It’s unlike any other field of employment. It’s a service industry that’s more labor and mind intensive than any other. In this day and age of 360 degree evaluations that have hit all corporate workplaces, the physician is faced with extreme scrutiny.

The patient, the nurse, the therapists, the attendings, and the insurance companies are all your bosses. While you may think that walking around the hospital in that white coat actually means something, the only thing it really means is that you have a white spotlight on you every minute you are involved with patient care.

Obviously, you must satisfy your patient. You must make them feel better, talk to them politely, and show a genuine interest in helping them out. As a physician, this is something that you enjoy. But the overzealous or over-worrisome patient can wear you out. If you let your guard down, you will likely hear about it. Nurses, therapists, and other attendings also can make or break you. If you are rude or misinterpreted, they simply won’t work for you. Your patients will sit on the hospital floor with needs that won’t be met because the nurses won’t call you because you are not that pleasant to work with. Similarly, other practitioners in medicine can significantly influence your professional reputation and your economic livelihood as a physician.

In the field of medicine, unless you are involved in emergency care, the invitation to participate in a patient’s care comes through referral. If you aren’t nice to everybody or if they hear something bad about you, you will not get many referrals.

Thus, every doctor must handle this baseline level of strain everyday in this service industry. I would venture that at some point in each doctor’s career, there has been an intense sense of paranoia about having to please so many people every day.

Next time you visit your own physician, you might take a closer to look to see if he or she is showing this stress.