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Physician, heal thyself

Doctors and all healthcare personnel are terrible at taking care of themselves

Physician, heal thyself
Doctors don’t get time for themselves.

Over my usual morning cup of tea, I read a brief article “Physicians experience grief in a different way”. Even though the article is ‘West-centric’ (it talks about nursing homes and other medical practices still uncommon in Pakistan), the point is still valid: doctors (and nurses and all healthcare personnel) are terrible at taking care of themselves. We spend our entire lives caring for other people and the whole time, the person who we need to be caring for is the one most neglected: ourselves.

It’s an interesting paradox because we are also accused, mostly by our families and those closest to us that we put them last. Conscientious physicians never hesitate to return a call or see a patient even if it’s the middle of the night, a holiday or a family gathering. This can be a source of strain on a relationship at times and can try the patience of a doctor’s own family, no matter how understanding they are.

Interestingly, the majority of research conducted on the subject of ‘doctor stress’ i.e. the work stress experienced by doctors (for the rest of this article, the word ‘doctor’ should be understood to mean any person engaged in the healthcare profession) reports that despite being pretty good at taking care of other people, doctors are not very good at taking care of their own physical and mental health. We often eat unhealthy diets, don’t exercise, don’t make time for rest and relaxation (let alone for healthy pursuits like hobbies and creative activities) and, as a result, suffer disproportionately from unhealthy lifestyles (like obesity, smoking etc.) with their attendant consequences — both minor illnesses like coughs and colds and more serious ones like heart disease, diabetes and the like.

In addition, doctors, due to the very nature of their profession, experience more of the phenomenon euphemistically referred to as ‘stress’. Long working hours, dealing day to day with sick people, lack of time to pursue healthy activities, difficulty balancing the demands of work and family life can lead to a host of problems which cannot be effectively counter balanced by a doctor’s generally higher income compared to the average person.

Long working hours, dealing day to day with sick people, lack of time to pursue healthy activities, difficulty balancing work and family can lead to a host of problems.

In addition, conditioned to the ‘Superman’ role, most doctors have difficulty asking for and accepting help when they need it.

Take the case of Dr B* who first came to see me because of anxiety related to an upcoming exam. He was a practicing physician who had already failed once in his ‘post-graduation’ examination, a pre-requisite for becoming a medical teacher. His daily schedule included teaching at a medical college in the morning, practicing at one clinic in the afternoon and a different one in the evening. His average day would start at 8am in the morning and end at midnight or later with no appreciable break in between, Monday to Saturday. On Sunday, he would drive to a different city (3 hours away) and do a clinic there from 10 am till 7 pm at night.

He had maintained this routine for several years. He was obese and had high blood pressure (although he was only in his late 30s). He often had difficulty sleeping, and was frequently irritable and snappy with his wife and two young children. The reason he consulted me was because of disabling anxiety due to an upcoming exam which he had already failed once.

A short course of medication combined with psychotherapy enabled him to pass his exam and he is doing fine (as far as I know) but there has been no change in his routine or his lifestyle. He is on course to develop serious medical complications over the next few years and another family or personal crisis will again plunge him into anxiety or depression making it impossible for him to continue working.

It is usually fruitless to engage a doctor in a discussion of lifestyle change. We are all so deeply ingrained into our social role that even the thought of modifying it makes us anxious. Our excessive devotion to work masks deep insecurities about our sense of self-worth and usefulness to others. As a result, in most cases, the only time a doctor will seek help is once their body (and/or mind) completely breaks down and they end up in the hospital or debilitated from a serious illness.

Dr S* came to see me after being referred by another doctor. She had been referred to me because, over the years, she had developed a serious addiction to sleeping pills and charas (referred to in the West as marijuana, a plant-based drug smoked or eaten recreationally). Because of her addiction, she had gotten into trouble at her job and had been threatened with being fired. She was accompanied by her mother and they bickered and fought continuously until I asked her mother to step out of the office so I could talk to her. She had been married once briefly (no children) but had now been single for many years. She lived with her elderly parents and, like most adult children still living at home, had a ‘hostile dependence’ on them. They argued and sometimes fought about what they considered was wrong with her lifestyle but did not want her to move away and leave them alone. She, in turn, hated being dependent on them but did not have the financial means to establish her own home.

Over several months I saw her off and on, mostly for ‘medication management’. It was obvious that there were deeper psychological issues related to, among other things, self-esteem, autonomy and the desire for a meaningful romantic relationship but most of those were buried under her immediate concerns: sleep problems, anxiety and anger problems being caused and worsened by her addiction. My pleas to her to engage in regular psychotherapy (sometimes called ‘counseling’) to work on the deeper issues kept falling on deaf ears. She would get a little better for a while, then disappear from treatment only to resurface a few months later in worse shape than before.

I tried to help as best as I could but of course none of her problems could be ‘fixed’ with medicines. I have not seen her for a long time now but I am sure she is still groping her way unsteadily through life, unhappy and directionless.

These are extreme examples, of course, but the fact remains: doctors are terrible at taking care of themselves. This is especially true in Pakistan where financial pressures drive most people to work long hours, all the time.

So the next time you go to see a doctor, you should be wondering when was the last time they got a full night’s sleep, whether they are suffering from an illness like heart disease or diabetes brought on by an unhealthy lifestyle and what they have done for themselves before they try to take care of you. If a doctor can’t take care of themselves, how can they reasonably be expected to take good care of you?

*Names and details have been changed to protect the persons’ privacy

Ali Madeeh Hashmi

ali hashmi
The writer is a psychiatrist and a Trustee of the Faiz Foundation Trust. He can be reached at [email protected]

2 comments

  • You are pointing at a symptom of burnout and blaming the victim here. You are using the medical/disease model to describe the conditioning we all absorb in our medical education.

    Doctors are programmed to be workaholic, Lone Ranger, superhero, perfectionists with two prime directives:
    The patient comes first
    Never show weakness

    This sets us up for physician burnout.
    ONE of the symptoms of burnout is complete lack of self care in the physical realm.

    We are programmed to burn out and the majority of physicians will do so over the course of their career. We are little robots focused totally on other people’s needs at a subconscious level. The programming runs deep.

    It is not that doctors are naturally terrible at taking care of ourselves. We are programmed to behave in this way. You blaming us … is like blaming a dog for running into the road and being hit by a car when you threw its ball into traffic.

    Dike
    Dike Drummond MD
    http://www.TheHappyMD.com

  • Drobaid ur rehman

    this is spot on.

    sometime we dont know how our week starts. the concept of rest is no existent especially on the surgical floor.

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