When I began my internship, I was the only one among my fellow interns who was not married. I was jealous of the boxed lunches that they carried, packed carefully and lovingly by partners at home. Several years later, after I joined the faculty at the University of New Mexico, I got married and realized that many in my intern cohort had been divorced by then. I received cautionary notes of congratulations from them. I wasn’t sure what had happened to their marriages but imagined that the long hours, the intense experiences of life and death, and perhaps the non-medical partner’s loneliness might have contributed. Over the years, I have wondered what might influence the success of a medical marriage, particularly as the proportion of men and women graduating from medical school has equalized.
The health of medical marriages is not only important for the wellness of the individuals in the couple but may affect the quality of care that they provide. Just as fatigue and inexperience can lead to medical errors, conflicts in relationships can lead to inattention to detail and more serious psychiatric problems, such as depression and anxiety, that may impair a physician’s ability to concentrate on complex problems, leading to errors that harm patients.
In their article on medical marriages, Perlman et al  investigated what seemed to be important to couples in medical marriages. While the qualitative study was meant to identify themes and not to test a hypothesis, the participants’ ideas resonated with me. The authors of the study identified four themes–shared values, mutual support, the important contributions of each family member, and the appreciation of being a physician. Based on my own observations, I believe that these issues are often linked. A physician’s identity involves acceptance of a set of values, such as putting the patient’s needs above your own, and unless those values are shared by both partners in the couple, it will be difficult to communicate about identifying time together. I also believe that a recognition of what it means to be a physician and shared values are linked to the provision of mutual support. Although the need for support will never be equal, the willingness to provide that support whenever possible creates the critical dynamic of mutuality in a medical marriage. In addition, it is far easier to support someone who is doing those things that you believe are important than someone whose priorities and values are different. A supportive extended family also can take some of the pressure off the couple particularly at times of stress.
The article by Perlman et al brings to mind Maslow’s hierarchy of needs.  According to Maslow’s hierarchy, the creative and analytic parts of our mind that we use for learning and problem solving during medical education will not be able to function adequately if our needs for intimacy, family, and friendship are not satisfied. Understanding and supporting a medical marriage can help us to provide the foundations for a healthy and successful career in medicine as well as a fulfilling life.