Every medical couple knows that the lifestyle and career choice brings with it adjustments and sacrifices. Physician spouses and partners often take on more housework and childcare to accommodate long working hours. Physicians may work unusual hours that lead to late-night arrivals, missed bedtime tuck-ins, and less face-to-face time. This can lead many couples to blame medicine for their struggling relationship.

Take the example of a resident who has been working long hours and has little time to spend with her husband. When Dr. Wife comes home late at night, husband starts listing the things that need to be done around the house, things that he always has to do because she is always working. The argument turns to her inaccessibility while she is at work. On and on they go, comparing how much time they each spend at their jobs, measuring exactly how much housework they each do, and explaining why they, not their partner, are misunderstood. Invariably, they reiterate the same arguments they have made a hundred times before and wonder why the outcome of these arguments is always the same.

Any couple stuck in this loop will tell you that it can be incredibly painful.  The interactions are characterized by palpable anger and a sense of hopeless and inevitable circularity. Eventually, that circularity becomes the norm, one that the couple easily falls into again and again. The conversations become an infinity loop with each partner triggering a predictable response in the other. The pain that at one time felt sharp and biting settles into a familiar ache.  It’s almost manageable.

Maybe, they each think, medicine is to blame. A career in medicine is too all-consuming. Maybe this is nobody’s fault.

No. Medicine is not the culprit. Yes, a career in medicine tests a relationship’s strength and stamina and yes, the sacrifices can lead to very real frustration. But blaming the physician lifestyle robs the couple of the chance to examine what is truly happening when they have this conversation again and again. What is this couple feeling beneath the anger?

I miss you.

I’m scared. We seem to be living parallel lives and I do not want to lose you.

I’m scared that you work long hours because you don’t want to be with me.

I’m scared that we can’t make this work and I don’t know how to fix it.

I’m scared that I’m losing myself in this relationship.

I miss you.

When the couple starts arguing about long hours, household responsibilities, or missed events, they dance around underlying issues and attack medicine instead. While anger is a primary emotion, it sometimes functions as a secondary reaction to underlying emotions like fear. But fear and vulnerability are incredibly painful to address because they ask the couple to risk rejection. Compared to that, arguing about a partner’s long shift feels safe.

For some, the vicious cycle escalates, and the physician decides that she might as well do the very things her partner has accused her of. She starts working longer hours, seeing more patients, and taking longer to complete tasks. Medicine is a great way to stay away from home, and it comes built in with morally superior answers for why the hours drag out. But avoiding the issue by working longer hours only creates misdirection, encouraging both partners to point at medicine and say, “See? It takes your time, your love, and your energy.” For others, the anger comes from a genuine place of hurt and an inability to see past the symptoms because the realities of medical life can be stressful.

Breaking those cycles is difficult. It involves writing a new script and exposing yourself to more difficult emotions. Still, an excellent first step might be replacing, “Why are you late again?!” with “I miss you.”

Sarah Epstein is a master’s candidate in couples and family therapy who blogs at Dating a Med Student.

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