Physician, heal thyself!

Most doctors do not outlive the general population. Are you taking care of yourself properly?

The global pandemic was a catalyst moment for medical professionals dealing with unprecedented stress levels. Dr John Cummins reminds medicos and other healthcare professionals to be aware of the impact of stress, taking time out to focus on their own mental and physical wellbeing.

“What is the extent of your own health care?” is a common question for all medical professionals. Australian medicos are hardworking but are faced by the sobering statistic: most doctors do not outlive the general population, and in certain medical disciplines many actually die younger than the general population.

This is indeed worrying.

The primary culprits are the same critical afflictions that account for mortality and morbidity in the wider population: cancer, and vascular illnesses such as stroke and heart disease as well as higher completed suicide rates in certain subgroups.

For vascular disease, up to 68% of men and 48% of women never get a warning before their heart disease or stroke declares itself, often with sudden death.

Risk prevention and check-ups are a sound course of action for all of us, especially after the age of fifty, but even more when dealing with asymptomatic disease markers – like a rise in cholesterol or blood pressure – that could go undetected until you have a medical event. With additional stress and work pressure added to the mix, conscious awareness of the risk factors and focusing on our own health makes much practical sense.

The pandemic’s height emphasised the magnitude of pressure faced by those battling the virus on the frontline. Our TV screens highlighted here and around the globe harrowing images of exhausted doctors, paramedics and nursing staff after long days covered in PPE, tending to critical care patients, while also caring for non-covid patients with everyday surgeries and critical care.

Vaccination rates, covid case numbers and mortality statistics led our daily news bulletins.

A difficult but well-documented fact for medicos was the rise of stress-related illness and mental health factors. Locked down populations may have been cheering from their windows and balconies for the life-saving work of hospital staff and medical teams in their scrubs, but for frontline workers the extended shifts, growing mortality rates (especially amongst their own) and risk of contracting covid took their toll.

Here is what we know about the health impact of stress: it has a strong correlation to heart-related illness and mortality. The InterHeart Study¹, a global study of fifty-two countries and 15,000 cases of heart disease, with 15,000 controls, estimated that the population attributable risk of biopsychosocial risk factors (depression, stress, adverse life events) for heart attack was 28% – with a significant risk persisting even when controlling for other risk factors.

Observational data shows that people under stress or strain have a higher risk of heart attack or stroke than people without the same level of duress.

A separate study² that looked at the covid stress of 13,000 healthcare professionals versus the general population, exemplified just how much stress health workers were under, hence increasing their personal risk of heart attack and stroke. The study was conducted across forty-four countries.

It showed that all healthcare workers were under more strain than the general population. Paramedics were higher than medicos within that subgroup while women had more stress than men but seemed better able to manage the stress than men.

The positives from this period for medical professionals? I believe many professionals – like the broader population – have begun re-examining their life, and made decisions to attain a more balanced life, at least compared with their pre-pandemic working levels.

The reason among my medico friends, including a respiratory physician colleague, is that they just got so tired. They needed, or in some cases found, via reflection: “look, I need to do some self-care here”. Being willing to do that, people have just reprioritised their life.

They might be saying: “Life is not just about chasing the dollar or overworking. I have got other more important things to do as well”.

Long covid 

Long haul covid, or long covid, is another recent and relatively unexpected medical condition causing stress. Right now, I have family members that cannot work full time. They contracted covid in late 2021 and are still flattened by the chronic fatigue. The stress is twofold in battling the symptoms but also worrying about lost income because they are working half time. If there was another argument for adequate insurance, this unexpected drop in income is it.

As with the Omicron variant, some 10% to 30% of us will get long haul covid, and it is no picnic.

Heal thyself!

The final message is that we in the profession of healing patients should not forget to heal ourselves. If the statistics concerning the impact of stress on the medical profession concern you (and they should) simply ask yourself: what really would it take for me to take stock of my own health and have a decent check-up?

A serious illness or warning, a death of a loved one for example?

If like me you figure out that life is to be savoured and enjoyed with optimal health and vitality, and I want a life where I can live a long life with a physiology of someone decades younger, now is a good time to reset and begin!

Dr John Cummins MBBS (Sydney University), FRACP, MPH (University of Minnesota) is Chief Medical Officer of PPS Mutual.