Professional Loneliness and the Loss of the Doctors’ Dining Room

The reflection piece by Dr. John J. Frey III offers valuable insights into the professional life of physicians. The author draws our attention to the disconnected workplace, in which physicians commonly practice, and the resultant professional loneliness characterized by much less face-to-face contact with colleagues and fewer informal conversations. On the other hand, relatedness and connection, as the author notes from his own experience, are the elements of physician wellbeing, which is critical for the provision of quality patient care [1]. Drawing on basic psychological needs theory (BPNT) [2] and our research with physicians and medical students [3-7], we would like to offer further insights on this matter.

According to BPNT [2], three innate human needs--autonomy, competence, and relatedness--must be supported in the environment (e.g., workplace) for individuals' optimal functioning and wellbeing. The need for autonomy is concerned with the extent to which a person feels that her/his goals and actions are self-chosen and self-endorsed. The need for competence is the degree to which a person deems she/he is effective in one's own actions and can achieve her/his goals. The need for relatedness refers to the extent to which a person feels connected with and valued by others. The three needs are considered interconnected and equally important, and "lacking autonomy, competence, or relatedness in any activity or domain of activity has detectable costs for both quality of motivation and wellbeing" (see [2] pp. 217-218).

Our research with physicians has revealed that when basic psychological needs were not met in the workplace, physicians experienced higher levels of stress and burnout frequency [3]. In contrast, when basic psychological needs were supported in the workplace, physicians experienced greater life satisfaction and were more likely to engage in lifelong learning practices [3]. Of the three basic psychological needs, the need for relatedness played the most prominent role in physicians' satisfaction with professional life, contributing to greater engagement and less exhaustion in the workplace [4].

Our research with medical students revealed that unmet psychological needs in the learning environment were associated with maladaptive cognitions and psychological distress among students [5]. In contrast, psychological need satisfaction had distinct pathways to beneficial cognitions and lifelong learning practices among medical students [5]. Of the three basic psychological needs, the need for competence was the strongest in explaining academic engagement and exhaustion [6] and the pursuit of mastery goals by medical students [7].

Taken together, our findings indicate that physicians' and medical students' wellbeing appear to rest on different needs (relatedness and competence, respectively). While it is paramount for students to focus on the acquisition of competencies for effective and safe practice of medicine, we, medical educators, are responsible for helping students learn how to relate and connect with each other within complex health care systems as well as helping students understand what drives them now and what will likely drive them in the future. As Dr. Frey points out "A profession is a culture, a way of seeing and acting in the world in which we live. A profession is learned from teachers, colleagues, and examples, both bad and good." (p. 463); "Remedying professional loneliness begins in training." (p. 462) Speaking from our own experience as medical educators, we regard teaching as having the potential to support our current and future physicians' need for relatedness in the workplace, resulting in an enhanced sense of professional wellbeing.

Oksana Babenko is an assistant professor, Medical Education, Department of Family Medicine, University of Alberta, Canada.
Joseph Abraham is an assistant professor, Undergraduate Pre-Clerkship Director, Department of Family Medicine, University of Alberta, Canada.
Sudha Koppula is an associate professor, Director of Faculty Development, Department of Family Medicine, University of Alberta, Canada.

References:
1. Bodenheimer T, Sinsky C. From triple to quadruple aim: Care of the patient requires care of the provider. Ann Fam Med. 2014;12:573-576, doi: 10.1370/afm.1713
2. Ryan RM, Deci EL. Self-determination theory: Basic psychological needs in motivation, development, and wellness. The Guilford Press: New York, NY, USA, 2017.
3. Ding M, Babenko O, Koppula S, Oswald A, White J. Physicians as teachers and lifelong learners. J Contin Educ Health Prof. (accepted)
4. Babenko, O. Professional well-being of practicing physicians: The roles of autonomy, competence, and relatedness. Healthcare (Basel). 2018;6:12. doi:10.3390/healthcare6010012
5. Babenko O, Daniels LM, Ross S, White J, Oswald A. A test of three motivation theories in explaining student well-being and lifelong learning. Educ Health. (submitted)
6. Babenko O, Mosewich A, Abraham J, Lai H. Contributions of psychological needs, self-compassion, leisure-time exercise, and achievement goals to academic engagement and exhaustion of Canadian medical students. J Educ Eval Health Prof. 2018;15:2. doi:10.3352/jeehp.2018.15.2
7. Babenko O, Oswald A. The roles of basic psychological needs, self-compassion, and self-efficacy in the development of mastery goals among medical students. Med Teach. 2018. doi: 10.1080/0142159X.2018.1442564

Competing interests: None declared