Doctors are Not Immune From Illness

This article originally appeared on Doximity.com, where I was a 2022-2023 Op-Med Fellow.

This is a difficult story for me to tell. It is about facing our humanity and our mortality as physicians. And it’s about the truth that despite our desire to view ourselves as insiders with the keys to the hospital doors, the pact that we have made is one-sided.

There is no covenant with the universe, no deal with the devil that if you save others, you yourself will be saved. I saw my physician father fall victim to this implicit belief after he became ill. I witnessed with sorrow his misplaced trust that he would be treated differently, and his difficulty in disengaging from his identity as a physician.

I’ll start by telling you about my father before his illness. He was a brilliant physician and researcher, an immigrant and outsider who worked his way up to the highest position in his specialty. He taught and inspired generations of medical students, residents, and fellows from around the globe. He was described to me years later by one of his former fellows as “a god.” He saved, mended, and assisted in the conception of countless lives through his innovative therapy and research.

My father was a humble man in many ways. But he refused to submit to becoming a patient, and that’s what was ultimately his undoing.

My father’s family history was riddled with heart disease and early death. His mother died of a heart attack at the age of 45. Most of his siblings died young. But he was a vigorous and proud man, and even when he suffered an unexpected and frightening episode of hypertensive heart failure after returning home from a conference, he refused to see a cardiologist.

I will never know what kept him from seeking help, but I believe that he was afraid of what he might learn. That all the years of work and sacrifice might eventually catch up with him. That he needed someone or something else to become physically whole again. That his health, and thus his independence, might be irretrievably changed. That he, like those he cared for and those he loved, was mortal and vulnerable. Truth be told, he refused to even go to the ER for evaluation. Instead, he sent my mother, a physician herself, out to the pharmacy for a dose of furosemide in the middle of the night. It was she who made the diagnosis, with her stethoscope and blood pressure cuff.

To us, his children, this somehow did not appear inappropriate or unusual. Our parents were true medical do-it-yourselfers. They always seemed to have everything under control, so why should this be any different?

Yet I recognized that something was off. At the time I was a medical student out of state, and during my calls home my dad regularly assured me that his blood pressure was a perfect 120/70 on a low dose of medication. I thought he was misleading me, but there was nothing I could do about it but believe him.

It should have come as no surprise that my father suffered a terrible hypertensive stroke several years later. It was severely disabling, and despite appropriate care, there was no hope of recovery. I will never forget finding him in the radiology department of the hospital, a local facility where no one knew him. Slumped in his wheelchair in a faded hospital gown, he was shivering, weeping, and demoralized.

This was the unraveling of the deal that he believed he had made. No longer the professor, the department chief, the innovator, he was simply the stroke in Room 402. He had gone from a man of the world to a random patient, unacknowledged and unremarkable.

Plaintive pleas for water, request for assistance to the bathroom, and upkeep of simple hygiene were addressed by staff with disinterest, although he received timely care. Instead of being acknowledged as a respected and dignified physician, he felt like an outsider, just another task for the busy staff who had no time or reason to think any more of him.

After my father returned home, there was a brief period of hope and even optimism that things might improve, despite the devastation recorded on his imaging studies. But what little recovery he made was unimpressive and ultimately gave him no freedom or chance of independence.

He had been beloved by his patients and revered by his coworkers, but after the first brief flurry of visitors, the world moved on and he was mostly forgotten. He desperately wanted to return to work, to reclaim his identity, to be of service. He was unable to drive himself, so after much anguished pleading, my mother agreed to take him for a visit to his hospital and research lab. He found himself disoriented, lost, and humiliated, subjected to the well-meaning pity of his former staff.

It was clear to everyone that his days as a physician were over. Only a sole colleague regularly came by to see him for the next seven years of progressive decline that preceded his death.

From my father’s devastating story, I learned several hard but ultimately sustaining truths. These lessons have informed my life and my practice of medicine. I believe they have not only made me a better physician but have allowed me greater freedom to explore and discover the world outside of our profession.

Although I’d like to believe otherwise, the crucial lesson I learned was that being a physician does not provide us with a teflon shield. As physicians, we spend tens of thousands of hours learning our profession, honing our skills, giving up much of our 20s and 30s in service to our calling. Most of the time, we offer this sacrifice willingly, knowing that by doing so we will be worthy of our patients’ and colleagues’ trust. Even after training, the climb never ends. We may lose untold hours of sleep, delay time with family, forgo relationships and other passions. We take on the weight of our patients’ illness, fear, even their anger at the whims of fate.

Surely the scales must somehow balance out for us in the end, a karmic destiny in this life. That is the deal that I believe my father made.

The truth is that physicians are human, no matter how invincible we may feel. My father’s sad journey taught me that. But if we need any further proof, COVID-19 has shown us that nobody is beyond the reach of sickness and death. I believe that it’s important to live life with that understanding.

To that end, I have made it my mission as a cardiologist to focus on preventive care. Paying attention to our own personal preventive health care is a simple matter of routine checkups and necessary procedures, along with a healthy diet and regular exercise. Addressing the sources of stress and dysfunction in our lives is equally important.

The time to act is now. Even with the best preventive practices, there are no guarantees, but these straightforward measures have the power to extend and improve the quality of the life we have. Waiting until retirement to take preventive care seriously may mean waiting too late. Through my father’s suffering, I was able to appreciate the importance of taking the earliest risk factors seriously. My patients valued my drive and care, even when they didn’t share my concern.

My father’s story also taught me that eventually, most of us will leave the fraternity of medical practice, whether we do so willingly or not. We must take the reins and be the driver of our own lives; otherwise we will one day find ourselves separated and bewildered, without a North Star to follow.

This guiding principle has led me to pursue interests and passions outside of the medical world that have enriched and opened up my life; among other things, I teach yoga and compete as an equestrian athlete. I believe the perspective I gained from my father’s experience also made me a better doctor. For this I am eternally grateful.

I retired from my cardiology practice in 2022 after nearly 35 years in the medical profession. I hope that when I need them, my former colleagues will be there to keep me well and care for me. But nothing is promised. And there is no time to waste.

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TechLink Health Podcast on Heart Smart Mindfulness

I often host the TechLink Health podcast, a show devoted to exploring the gamut of new technologies and innovations in health care. I began this journey as a guest on the podcast in 2022. The interview went so well that I was subsequently invited to host.

It’s been a lot of fun, and I always learn so much from our guests. My experience is a great example of what can happen when you take chances and say yes to opportunities that align with your purpose, even when you don’t know exactly what will happen next.

This week I’m re-sharing my first episode. The conversation ranges from insights on maintaining heart health with a busy lifestyle to the role of mindfulness on outcomes in healthcare, and the importance of addressing issues that lead to burnout in physicians and others. We also discussed the ways a creative practice can help physicians and others in healthcare.

If you’re interested in accessing some of the resources we discussed, I’ve linked to them below.

📗 The Bullet Journal Method

📙 Real Change

📲 Insight Timer: The #1 free app for sleep, anxiety and stress

📲 The Waking Up App

📲 Headspace

📲 Calm

📲 Yoga: Down Dog

A version of this article originally appeared on this website in November, 2022

DISCLAIMER: As an Amazon Associate I may earn from qualifying purchases, which means that if you click on one of the product links, I’ll receive a small commission. This helps support the website, for which I am grateful! Please do your own research before making any important decisions.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Thriving Amidst Chaos: Prioritizing Health, Self-Care, and Mindfulness

In the constant press of your daily life, prioritizing health, self-care, and mindfulness often takes a backseat. But when you make the time to care for yourself, you’ll be better equipped to care for those who depend on you.

In this article, we’ll explore why self-care matters, including the impact of self-care on stress management, and I’ll give you some simple steps that will help you to thrive amidst the daily storm of clinical practice.

The Impact of Stress on Burnout

It’s common to think of stress as harmful and something to be avoided. But stress can affect your health positively as well as negatively.

Positive stress happens when you face a challenge or a deadline that you know you are capable of meeting. It might be a stretch, but you know it’s possible. And importantly, there is a reward on the other side.

While positive stress can propel you towards your goals, negative stress can lead to frustration and burnout. Negative stress is defined as those forms of stress over which you have no control. A boss (or spouse) who is never happy, a job for which you are never rewarded or thanked, and escalating demands at work without adequate time off to recharge are all forms of negative stress.

Constant and unrelenting stress can lead to burnout. The World Health Organization defines burnout as an “occupational phenomenon.” Burnout is characterized by

• Exhaustion and loss of motivation

• Cynicism and negativity

• Inefficiency

Given the current state of healthcare, it’s no surprise that over 60 percent of physicians reported at least one manifestation of burnout in 2021.

It’s important to remember that burnout is not your fault. It is a symptom of a dysfunctional system or workplace. But developing some tools to help you get through tough times can lessen the impact and improve your overall happiness and wellbeing.

Self Care and its Benefits

Self-care is not just about pampering yourself. It's about taking care of your mental, emotional, and physical well-being.

Committing to self-care enhances focus, improves relationships, reduces stress, and leads to less burnout. Acknowledging the mind-body connection is often the first step towards effective self- care.

Nutritional Psychiatry and Stress Management

The new field of Nutritional Psychiatry focuses on the growing body of research that strongly connects what you eat to how you feel. Without a doubt, mental health is complex and multifaceted. Diet is only one part of the big picture.

But when you’re famished and pressed for time, the quickest options can undermine you, sabotaging your best intentions and sapping your energy.

As it turns out, those ultra-processed foods that often pass for nutrition in the doctor’s lounge can raise your risk of anxiety, sleep disturbance, depression, food addiction, alcohol use disorder, and increased inflammation. Artificial sweeteners in particular have been linked to a greater risk for depression.

Instead, consider incorporating simple elements of the Mediterranean diet like fruits, nuts, whole grains, olive oil and fish. You probably know that the Mediterranean diet supports heart health and may reduce the risk for certain cancers. But this diet is also linked to improved symptoms of depression and better mental health and well-being. There’s also emerging evidence that a Mediterranean diet can improve perceptual performance.

It might take a little planning, but going Mediterranean doesn’t have to be complicated. Simply packing a nourishing lunch or advocating for healthier options at work can make a difference.

Exercise and Health

You already know that regular exercise will lower the risk of heart disease, cancer, bone disease, and dementia.

But research has also shown that exercise can reduce anxiety, improve sleep, and improve immune function. It doesn’t take a lot of exercise to reap the benefits. A brisk walk a few days a week is a great way to get started.

Mindfulness and Self-Care

"Mindfulness is the awareness that arises when we nonjudgmentally pay attention in the present moment.” These are the words of Jon Kabat-Zinn, PhD., Professor of Medicine Emeritus at the University of Massachusetts Medical School, and the godfather of mindfulness in healthcare.

Put even more simply, mindfulness is undistracted attention.

Practicing mindfulness can lead to

• Healthier lifestyle choices

• Less stress and anxiety

• Greater parasympathetic tone

• Better cardiovascular health

• Improved immunity.

Mindfulness doesn’t have to be about doing yoga or meditating. Instead, it’s about being undistracted, nonreactive, and fully present in the moment.

Getting started with mindfulness isn’t complicated. You don’t need a special cushion or a meditation app, although those can be nice. Simply set aside 3-10 minutes of quiet time each day to observe the present moment. Notice your thoughts and let them go, returning to the present when your mind wanders.

It is this practice of continually returning to the present moment that develops the “mindfulness muscle.”

When you practice mindfulness, you may find that your communication with patients and colleagues becomes easier and more engaged.

Create an Action plan

Creating an action plan will help you to set realistic goals and track your progress. Write out the steps that you need to take to commit to your self-care. And develop a plan that is realistic and actionable.

Enlisting a partner or friend with whom you can share accountability can help you to stay committed. Something as simple as a daily reminder on your phone may also keep you on track.

The ripple effect of taking your own self-care to heart will show up in your energy level, creativity, and relationships. You’ll develop a greater sense of self-compassion and equanimity. And in time, your path forward toward the goals that matter will become more clear.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Adan, R. A. H. et al. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 29(12), 1321–1332.

Davidson, R. J. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564–570.

Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, et al. (2022). Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults. British Journal of Sports Medicine 56:1188-1193.

Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234

Lane, M. M. et al. (2022). Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 14(13), 2568.

Loucks, E. B.et al. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current cardiology reports, 17(12), 112.

Martinez-Gonzalez, M. et al. (2019). The Mediterranean Diet and Cardiovascular Health: A Critical Review. Circulation Research 124:779-787

Munoz, M.A. et al. (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition. 101 (1821-1827),

Samuthpongtorn C et al. (2023). Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770

Shanafelt, Tait D. et al. (2022). Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings, Volume 97, Issue 12, 2248 - 2258

Stubbs, B. et al. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249, 102–108.

World Health Organization: WHO. “Burn-out an ‘Occupational Phenomenon’: International Classification of Diseases.” World Health Organization, 28 May 2019, www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.

Yin, W. et al. (2021). Mediterranean Diet and Depression: A Population-based Cohort Study. International Journal of Behavioral Nutrition and Physical Activity, 18(1). https://doi.org/10.1186/s12966-021-01227-3

Young, H. A. et al. (2022). Mediterranean diet, interoception and mental health: Is it time to look beyond the ‘Gut-brain axis’? Physiology & Behavior, Volume 257.