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Think of all the times you’ve said, “Yes, dear” to your spouse as opposed to telling him or her what you really think. Funny how these things—resentments, that is, build up. Whether in a marriage or an orthopedic practice, resentments and the accompanying stress can take their toll.

Wayne Sotile, Ph.D., stress expert and consultant to the medical profession, has worked with thousands of physicians. “The primary issue that decides work satisfaction for a surgeon is how well that person gets along with others. All other things flow from this. If you have a collegial environment where things are peaceful, it is easier to focus on and accomplish your work.”

The trick is to value a peaceful environment more than an extreme sense of control. Explains Dr. Sotile, “Many doctors have never thought of this, but what makes one successful as an orthopedic surgeon is not necessarily what is going to make you a successful leader or team member. These are really two different mindsets, with surgeons very accustomed to being in charge of their own destiny and wary of anything that’s a threat to their control. But that doesn’t jibe well with the business of medicine. Surgeons today need alliances with office managers, nurses, and others in order to create a successful practice. What stumps some surgeons is that the bigger the alliance, the less control they have over the alliance. In those situations where a real sense of business sophistication is called for, surgeons may feel anxious if they lack this, and thus lack a sense of control. I have even seen some anxious surgeons initiate chaos because they know how to handle that. All they have to do is use the skills and traits they already possess such as independence, stoicism, and task focus. These are tangible things that beget specific outcomes—something that makes them feel comfortable. Surgeons have told me, ‘When things started getting stressful at work I went back to the lessons I learned early on, namely, put your head down, take one case at a time, and go home.’ They sometimes forget to lift their heads up and notice the impact their actions have on others.”

But for most orthopedic surgeons, there is a built-in sense of teamwork. Says Dr. Sotile, “I have conducted more than five thousand presentations to medical organizations across every specialty. Without question orthopedic surgeons are the most collegial and collaborative of physicians. Our research shows that when that collegiality is violated there is nothing that drives burnout more quickly. To have a successful workplace you must have trust—and that means no hidden agendas or nasty politics.”

To build trust and reduce stress, it’s important to look below the surface. “Think not so much about the superficial content of the issues, but consider the issues underlying the content, and the process of how you approach them. Most issues aren’t resolved by eliminating the content because there are hidden things, such as power struggles, going on between people. Regardless of the content, you should structure your time and energy so as to give relationship building a chance. When practices ask me why they lack teamwork, one of the things I tell them is that they need to talk about how they work together. They need to make an investment by having regular meetings to discuss the status of the organization. In the process of this, you get to know each other and develop familiarity and hopefully, trust. Take a look at the day-to-day process of how you interact with others in the practice. In this world of long-term thinking, taking time to say, ‘Thank you’ and clean up the messes of the day are some short-term investments that pay off in the end. And don’t make the mistake of just getting to know a few people. This would mean an uneven communication pattern in the practice where factions develop and issues fester and remain unresolved. It’s a breeding ground for things that erode trust.”

As an example of a road you don’t want to take, Dr. Sotile says, “I once consulted with a 12-surgeon group that was completely lacking in trust. They had never been to a single meeting together; the meetings that were held often deteriorated into screaming matches and would last from 6 pm to 3 am. There were factions and gossip—they were falling apart. I was called in to help because they realized it would cost them $100 million to ‘divorce.’”

But back to control issues. Well-trained and confident, orthopedic surgeons are accustomed to a certain level of independence. Increasingly, other parties are having a say in how they practice. States Dr. Sotile, “Another stressor for orthopedic surgeons is any interference with their sense of autonomy. People are telling them what implant or medicines they can use based on cost. It’s the medical economics of orthopedic surgery. For example, I know a surgeon who was trained at the Mecca of joint replacement and became accustomed to using a certain manufacturer’s implant. The hospital he works in wanted him to use another implant because it was less expensive. This puts a lot of pressure on surgeons because they are being forced to make compromises. They have to weigh things out and ask themselves, ‘Is this a violation of my professional ethics or am I being hard-headed?’”

Such questions invite more questions and move the surgeon into the gray zone. This can be helpful as it may be tempting to think in black and white. “Do an assessment of the driving ethic of the universe in which you practice,” recommends Dr. Sotile. “Oftentimes it is a traditional, ‘I’m used to being in charge.’ I have noticed that people who are upset about having to compromise their control normally say, ‘I am angry because I’m trying to do the right thing and these people want me to do the wrong thing.’ There is a lot of gray out there, however, so it’s wise to take a look at the full picture. Part of that includes realizing that in every specialty, as an organization grows, there is a push for more standardization. This happens because it results in better control of the economics and better teamwork. If there is really nothing you can do to alter a situation, my message is quite Zen: control what you can control.”

Continues Dr. Sotile, “Whereas surgery is a high demand, high control situation, office hours can be less stimulating and often involve the frustration of dealing with patients who haven’t taken the surgeon’s advice. A day at the practice means a high demand, low control environment. The orthopedic surgeon knows that the effects of his or her surgery will be better or worse depending on how well the patient has adhered to the treatment plan. Having a dynamic, collegial team can be an especially great stress-reliever when situations like this arise. The medical literature recommends that doctors develop a philosophy that helps them tolerate, with less self-punishment, the pitfalls that come with medicine. In some specialties it’s, ‘OK, I can’t save every life.’ In orthopedic surgery it’s, ‘OK, I can’t make every patient happy.’ It’s work, but surgeons can achieve an attitude such as, ‘I can only do my best. I can make available the best services to my patients and maintain a posture of compassion when dealing with difficult patients.’”

Building up a mountain of stress, as opposed to handling each situation as it arises, is a recipe for disaster. Says Dr. Sotile, “If you fail to recover from every little [and big] stressful incident, your autoimmune system will be worn down. Your baseline level of stress will increase after each incident. By pausing, taking deep breaths, thinking calm thoughts, playing music, and taking a moment to connect with others, you can reverse the stress. The point is, ‘Don’t hold it in and don’t wait to de-stress.’”

Gee, but then the implication is that de-stressing is needed. And doctors are supposed to be superhuman entities that can handle anything, right? Perhaps in a parallel universe. But here on earth, stress can affect anyone. “There are surgeons who laugh and say this is all psychobabble,” says Dr. Sotile. “Turning the stress issue into a joke is just a way of invalidating it. When I encounter someone with this attitude my response is, ‘Your relationships aren’t going to feel any better than you do.’ I also say to someone like this, ‘Let me interview your nurses and spouse.’ Also, I ask, ‘If your physician’s assistant knew you were coming to this session, what would they privately hope you would learn?’ I want them to understand that stress is a human problem, not a doctor problem.”

Continues Dr. Sotile, “Super-achieving athletes know they need to take care of the ‘machinery’ in order to be successful. Tiger Woods has turned down the Emory tournament because he is tired—and he lets it be known. I recommend that surgeons not get confused about what’s normal. The kind of high-pressure work they do isn’t normal to start with. Given that, it is important that they be diligent about managing their resilience. For 30 years I have watched doctors struggle to balance a myriad of responsibilities, stressors, and their own internal messages about how ‘strong’ they need to be. The ones who start attending to their stress levels before the third divorce, heart attack, and burnout are the ones who succeed on a daily basis.”

So look at what you’re collecting. Do you have more positive or negative interactions on a daily basis? States Dr. Sotile, “Every practice should recognize that it will have chronic unresolved issues, just like happily married people. The key is to generate more positive than negative experiences. Otherwise you accumulate negativity, which could poison both your work and home life.”

If that’s not enough motivation, take a look at the books. Says Wayne Sotile, “It costs $60,000 to replace a practice manager, $60,000 to replace a nurse, and $250,000-$350,000 to replace a busy specialist. While you can’t take responsibility for making everyone in the practice happy, you can handle your own stress, connect with others, and help to create a collegial environment.”

And do you need yet another inducement to take care of yourself? The anxious patient on the exam table with the torn rotator cuff. Her nerves plus your stress is a bad combination. So turn yourself into a walking experiment…if only for a month. Choose one or two stress management techniques and try them on. They might fit as well as the white coat.

Wayne Sotile is a healthcare consultant and keynote speaker. His latest book is Letting Go of What's Holding You Back. For more information, visit www.Sotile.com.