Rushing–as usual–into the hospital on my way to work, I darted past the elevators where one of the hospital operators was kindly holding the doors open. I waived him on with a friendly “Good morning” and headed instead to the stairwell. When I passed him, I heard him mutter, “Doctors, they always take the stairs.” Little did he know that climbing a few flights of stairs might amount to my only exercise for the rest of the day (that, and walking my dog for his “morning constitutional.”).
I began thinking about the self-care routines of my colleagues and myself. How healthy were we as a group? What healthy behaviors do we follow, and which ones do we not? Are we setting a good example for our patients?
Like the rest of the population, we too are getting heavier, but at a somewhat slower pace–a little over half of primary care doctors are considered overweight or obese, as opposed to 2/3 of the rest of the population (N. Shute, NPR report, June 5, 2013). On a more positive note, we are pretty good at not smoking. Smoking rates dropped dramatically among physicians from the 1970’s to the 1990’s, down to 3.3% by 1991 (Nelson et al., JAMA. 1994;271(16):1273-1275), compared to 25% in the general population around the same time.
The bigger concern appears to be our mental health and the health of our relationships. Doctors have extraordinarily high divorce rates, by some estimates, 10-20% higher than in the general population. We also show high rates of depression, prescription drug abuse, alcoholism, and suicide (female physician suicide rates are 4X that of other women). Medical researchers are doing their best to clarify these trends and explore possible causes. In their stark and startling article “The Painful Truth: Physicians Are Not Invincible (Southern Medical Journal, 2000, 93(10): 966-973),” Miller and McGowen describe the “culture of medicine,” beginning with and extending beyond our sleep-deprived medical training, where we ultimately learn to shut ourselves off from our feelings in order to cope with the daily tragedies and despair suffered by our patients.
As a critical care specialist for the past 25 years, I have continued living the life of a resident, spending way too many nights in the hospital. I see firsthand and have even participated in the macabre humor borne from the pain we witness, fueled by exhaustion. I recall during residency when I once told the emergency room attending physician trying to admit the umpteenth patient to me in the middle of the night that I simply refused to admit anyone else to the hospital…unless it was GOD–to which she replied, “The patient is as old as GOD.”
Beginning to fray from my evolving burn-out, I was advised this year by my very wise spouse to read Trauma Stewardship (Berrett-Koehler Publishers, Inc., San Francisco, CA; 2009) by Laura van Dernoot Lipsky. In it she describes the 16 warning signs of the “trauma exposure response,” or ‘vicarious traumatization’ that can develop in those repeatedly caring for others who have experienced trauma. I devoured chapter four of her book with highlighter and annotations as a former medical student would. Maybe you won’t see all 16 of the signs in yourself, but maybe there will be enough of them to finally hear that wake-up call–to take better care of yourself while taking care of others. I know I did. As a result, I changed my schedule to include “walk the earth” days on a regular basis, even (especially?) playing hooky on a weekday. I leave my computer at home and place my cell phone on silence. And I walk out my door. And take the stairs.
–Melissa Lim, MD
Pulmonary, Critical Care, Sleep specialist
Redwood City, CA