Personal pressures in medicine. How to recognize and manage your grief reaction.

Many physicians in private practice are recognizing the tremendous changes prepaid health care systems have imposed on the relationships among the physicians, hospitals, patients, and health care companies. A physician's practice patterns now must reflect utilization review standards, cost containment considerations, and defensive medicine practices. Many of the negative feelings expressed by beleaguered, angry physicians can be considered a grief reaction to changes in the profession. Resolving the grief reaction involves evaluating the perceived losses of autonomy and authority. The questions asked by employers and third party payers as well as some new axioms for physician involvement in health care delivery can be seen as a means to help physicians reorient themselves to meet these challenges in practicing medicine.