For the first time in their long histories, the American Medical Association and the AMA Alliance have co-released a book (ours!) that describes the secrets of thriving medical couples. This event means something worth noting: Today's medical families are the new pioneers; you are a generation of men and women charting your ways through as-yet uncharted territory. The "road maps" that prior generations of physicians and physician loved-ones used to determine what they needed to do in order to be successful at home and at work simply do not apply anymore. Ours is a new day, and, creative institutions, hospitals, practices, and couples are recognizing that work/family balance issues are primary among the concerns of contemporary physicians and their loved ones.
In our 23 years of practice, we have had the privilege of treating more than 700 physicians. Thousands more have attended our medical marriage workshops and keynotes. These experiences have given us private glimpses into the inner workings of many "types" of medical marriages. We have found that, independent of the form - the doctor and his non-physician wife; the doctors; or the doctor and her husband - successful medical families distinguish themselves in clear ways from their less fortunate comrades. In a nutshell, these thriving medical couples are modern-day heroes; not just in terms of performing extraordinary fetes, but, even more, in our definition of the term: Heroes create safe spaces for other people.
In this article, we present eight of the key lessons we have learned from these heroic medical marriages, those folks who live busy lives and still manage to keep their love and passion alive.
Give up the myth of the balanced life. Beware of the "Beaver Cleaver" family myth of the 1990's: the notion that healthy people live wonderfully balanced lives. Nothing could be further from the truth! No one lives in perfect balance between work, family, marriage, and self-focused pursuits. Furthermore, contrary to the popular "new-age guilt" rhetoric, it's okay to love your work! In fact, the happiest and healthiest of people tend to have high levels of passion, both for their loved ones and for their work.
Don't mis-construe the term. Balance does not refer to a static state. It is a dynamic process that involves regularly adjusting one's stance. Balance is more analogous to walking across a stream on rocks than standing still. Thriving medical couples do, indeed, go through periods over-focusing on one aspect of life or another (work, family, marriage, self). The key is that they do not lock-in the "wait-until" mentality and let any important aspect of their lives atrophy from chronic lack of attention.

Slow down, in spurts. The antidote to the "wait-until" lifestyle is taking care to create at least moments of caring connection with loved ones, especially during the busy stretches. Given that three times as many physicians work 60 to 80 hours each week as any other professional group, it would be fool-hearted to wait until the work schedule clears before paying loving attention to your family. The good news is that, when it comes to improving the quality of your relationships, little changes yield powerfully positive differences. Thriving couples do, indeed, tend to live busy lives. But along the way, they follow a few guidelines that are worth emulating:
-Never turn a monthly calendar without blocking out a 12-to-48 our period of time that you designate as "marriage time." Protect that commitment just as you would your on-call schedule or your commitment to take your child to his orthodontist appointment. And show up with your teeth brushed and your hair combed! Most couples lose their romance out of neglect; not out of lack of love.

-Each day, find time to have multiple, brief, loving interactions with each. Think for a moment about the many ways that take less than 20 seconds that you can say to each other "I love you" or "I appreciate you" or "I admire you" or "I miss you." Periodically throughout each day, take 20-second breaks to make contact. Try doing this for a total of 10 minutes every day. It can help you to stay connected, even during the difficult times.

Manage the relationship consequences of your high-powered coping styles. It's a two-part fact: (1) High-performing people tend to marry each other; and (2) High-performing couples tend to develop coping habits that serve them well in managing their BIG LIFE, but these same habits may hurt their relationships. We refer here to those wonderfully adaptive coping skills like multi-tasking (doing and thinking multiple things at once); being goal-directed and efficient; hyper-vigilance (scanning for flaws, and correcting them); delaying gratification; or staying focused on work and achievements. All of these are positive and necessary ways of coping....sometimes. But our relationships suffer when we over-use these tools. Remember: What makes us successful at work does not necessarily make us successful at home.
Do your family a favor: Someplace between where you park your vehicle and
enter your home, place a reminder --- "No superpeople live here." Remember: No matter how noble your intentions, your loved ones only know you based on how you treat them during your day-to-day interactions.


Protect your communication-generating rituals. Every couple starts out with a wonderful set of rituals that create time and space for them to give undivided attention to each other. What were yours? Healthy medical couples don't do anything extraordinary here. After all, no one wants to spend hours each day, discussing their innermost insecurities and fears. (Most of us would rather have a root canal!) No, the "rituals" that thriving couples maintain are much smaller; much more gentle and realistic. Maybe it's taking time to leisurely read the Sunday paper --- not in parallel silence, but together, interacting about interesting points. Some develop the habit of setting aside 20 minutes each evening to sit and chat in a quiet room. Others make mealtime a time to sit at table for an extra 15 minutes, just to touch base. Still others protect their weekly walks together, their Tuesday night "recesses" (no working, nor worrying, no discussing anything "heavy"). It doesn't matter how you do it, just do it! R

Celebrate your differences as man and woman. When it comes to communication and intimacy, are men and women really that different? In our opinion, the popular rhetoric on this topic borders on normalizing stuff that just isn't true. Sure, men do tend to be more action-oriented and more problem-solving in their communication tendencies. And women tend to more easily and more frequently talk about their feelings. But this doesn't mean that we are doomed to suffer through marriages filled with mis-communication, justifying our misunderstandings with "that's just the way men/women are" notions. Healthy couples stretch to meet each other in the middle of this gender shuffle. They learn to appreciate and to participate in their partner's styles of communicating and showing love. Put another way, healthy medical marriages orchestrate various dances of intimacy. A few examples follow:
-Sometimes, he just listens, taking care not to offer advice. Instead, he simply offers empathy and compassion.
-Sometime she accepts that watching a ball-game or a golf match together is a bona fide form of intimacy.
-Sometimes, he's just physically affectionate, independent of any sexual agenda.
-Other times, she decides to bridge their distance by being sexual.

Be unpredictable. This might at first feel awkward. But putting new steps into your relationship dances will keep both of you interested and interesting. If you find yourself feeling bored, take a hard look at yourself. Ask: Am I bored, or boring?

Don't expect your relationships to feel any better than you do. Our clinical experiences suggest that both mates in a medical marriage tend to be scripted to be care-takers. If you are like most physicians and physician spouses we have known, you probably are great at ignoring your own needs in deference to taking care of others. This puts you at risk of developing a numbness that blunts your ability to stay connected with the very people you are so invested in taking care of. Don't forget to nurture your own mind/body/spirit; rejuvenating yourself is the best way to preserve the energy you need to nurture others.

Remember: It's never too early nor too late to make your marriage better.
When the American Medical Association asked us to revise our book, The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their Families, we did so with glee. Not only were we excited about the compliment of AMA's endorsement; we were also anxious to add to our original manuscript a chapter on marriage in the second half. Responses to our "Dancing in the Empty Nest" chapter have, indeed, proven the point that it's never to late to rejuvenate your marriage.

Once the kids are grown, medical couples face new opportunities and challenges. The second half of marriage is a time to look back with pride on what you have done and what you have endured; to forgive each other for mistakes you've made; to find new ways to spend time together; to dis-inhibit your sexual relationship; to renew your friendship; to establish new levels of nurturing companionship with your grown children; and to notice and express appreciation anew for all that your partner does and has done for you and your family.

But you don't have to wait until retirement to enjoy variations of these relationship- boosters. Even during the busy, child-rearing, career-building days of your journey, be sure to regularly carve-out islands of time to attend to each other. The emphasis here is on "regularly." For example, we often advise busy medical families that, in terms of constructing a healthy marriage and family life, it is far better to take 20, two-day "vacations" each year than it to take two, 10-day vacations. For a family to stay healthy, they must regularly take "recess" together. You need to frequently show each other your playful, joyful sides. Counterbalance your tendencies to work, worry, or teach your children with many, brief periods in which you simply be present, be playful, and be attentive. Remember: We fall in love with people who make us laugh; we stay in love with people who make us feel safe enough to come out and play.

Be Generous and Be Gracious.

There are no perfect people. There are no perfect marriages or families. Along the journey that is a lifetime marriage, we make many mistakes; we encounter many disappointments; and we regularly fail to please those we most love. This is just as true for thriving medical couples as it is for those who divorce. But loving families do something that safeguards their trust and friendship, even though they make mistakes: They treat each other with generosity and graciousness.

Be generous in what you offer to your loved ones. Offer them "gifts" that make them feel safe and special in your presence, even if offering their preferred forms of communication, affection, or attention feels awkward for you. And be gracious when responding to the "gifts" your loved ones offer to you, even if the offering is not exactly what you wished for.

If we are to stay the course and remain stress-resilient at work and at home, we must find ways to keep our marriage and family relationships healthy; doing so is the ultimate act of heroism.

*This article was originally published in Minnesota Medicine.