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Who’s taking care of you?

July 2008

When it comes to the health of hospitalists, the discussion can be very challenging.

For one, when talking about physicians’ attitudes toward health, it’s easy to sound sanctimonious, like you’re wagging a figurative finger. And two, there isn’t much in the way of published studies about the health of doctors, let alone hospitalists.

After an exhaustive search, I did come across one interesting article published by the British Medical Association in April 2007 that found damagingly high levels of stress in both older and younger physicians due to “excessive workloads, organisational changes, poor management and insufficient resources.” Sound familiar?

Do we as physicians take better care of ourselves then nonphysicians do? Do physicians live longer? Most of us would assume the answer is “yes,” given the fact that we know what is good (and what is not) for maintaining a healthy lifestyle.

But one common “bad habit” that I have noticed (and even personally experienced) is not paying enough attention to diet, including what we eat and when we eat it, particularly when working long shifts. We all know that a good breakfast is the essential foundation for a robust work day, but how many of us eat a proper breakfast? As for myself, there have been countless times when I have skipped, delayed or at best wolfed down lunch. And after working night shifts, I crave a big, greasy breakfast–and have succumbed to the craving unashamedly!

Just out of curiosity: When was the last time you saw a physician and had a complete check-up with all the primary care screenings? Come on, own up. Are you due–or overdue–for routine health maintenance? Do you routinely self-diagnose and self-medicate instead of seeing another physician?

Do you get regular periodontal check-ups? When was the last time you went to the gym, for a jog, or took a long walk or hike? When did you last take time to smell the flowers or do yoga or tai chi?

Do any of these questions make you feel guilty? I’m often guilty of not taking the best possible care of myself. I certainly try, and I enjoy biking, tennis and swimming. I also go to the gym whenever I can. But when all is said and done, I could do better.

Let’s broaden the discussion, and look at how much emphasis is put on physicians’ well-being in our training, our hospitals and our health care system.

I often find myself drawing an analogy between the health care industry and the airline industry. I have airline pilots in my family who routinely undergo mandatory, periodic check-ups as one of the prerequisites for maintaining their ability to fly. The airline industry has strict restrictions on the number of hours a pilot can fly in a single stretch, an acknowledgement of the negative impact that fatigue and lack of sleep has on performance in a critical job.

Studies have looked at how the lack of sleep affects clinical performance. According to this editorial, sleep deprivation equals the effects of acute alcohol intoxication in the early morning after nearly 24 hours sans sleep. And my co-blogger Erik DeLue uncovered an article that found an increased risk of cancers in folks who predominantly work the night shift.

Is it safe to extrapolate from the airline industry and make a case for imposing similar rules on physicians? Will the medical community see such rules–requiring doctors to undergo physical and mental evaluations and pass muster to maintain credentials–as an infringement of their autonomy? Or will the majority embrace such a requirement whole-heartedly?

I can see strong arguments for each side of the issue. By and large, hospitalists are a younger breed of doctors. Some of us are still reveling in the invincibility of youth, while some of us are staring at the prospect of having our prostates examined or submitting to some other unpleasant but necessary screening test.

Are the newer doctors joining our field receiving more training on how to maintain health and well-being over the course of their professional lives? And are hospitalists more at risk for certain types of health issues then other physicians?

I don’t know the answer to those questions. My best guess is that besides nosocomial infections and the usual occupational hazards–needle sticks and irate, out-of-control patients or family members–we are no more at risk than other physicians. It would be interesting to follow a cohort of hospitalists longitudinally for five years to see what our health data reveals.

What about stress? There is the good kind of stress (eustress) that keeps us on our toes and allows us to rise to a given challenge. Then there is the bad kind of stress (distress) that precipitates various psychosomatic disorders. One British study found that 28% of physicians and health care providers reported abnormal levels of stress as opposed to an 18% prevalence in the general population.

Do we cope with stress in a positive way? Are medical schools fortifying future physicians with techniques to deal with stress? I have often heard that some degree of obsessive compulsive behavior is common among doctors. For the most part, that extreme attention to detail is, it can be argued, a good thing. But at what point does this trait tip over into dysfunctional perfectionism?

And how do we perceive illness among colleagues? Is illness seen as a sign of weakness and vulnerability? Do we expect ourselves and each other to make personal well-being subservient to our responsibilities of caring for patients, to the point that we report to work even when we are ill?

The more you delve into the topic of physician health, the more complex it becomes. There is, however, no doubt that to take care of patients to the best of our abilities, we need to be in the best possible physical and mental state. It is up to us to ensure that we take good care of ourselves, not only for our own sake, but for theirs.