Introduction
A physician
in our group died.
That in
itself is not surprising; every one of us will. But when a colleague
dies, it's a little more personal. Perhaps we see ourselves in that
physician; we think about our own mortality. Could we have done something
for that person? Can we do something for ourselves?
How do we come
to make choices about self-care?
Selflessness
is a personality trait of most physicians. We have extraordinary demands
from our work. The coordination of patient care, the communication between
physicians, the number of patients on our panel all speak to how we
care, how we have decided to go into a field where caregiving takes
precedence over almost anything. Physicians often place the needs of
every patient before their own. We give up sleep in residency, give
up evenings and nights for our call schedules, give up concentrating
on eating lunch, and give up our own nights with our families for administrative
meetings. Slowly, the accolades of a dedicated physician at work lure
us into giving more time to work. We give up the necessities of sleep,
play, and even give up taking care of our own health. In medical school
and residency, we were trained to deny our own needs and desires. Another
important meeting at night? It will be all right, we tell ourselves.
Don't have time for lunch? It will be OK. It happens to many physicians;
we give up caring for ourselves in order to serve the group.
Why Are We Often
Not Good Caregivers for Ourselves?
More often
than not, we are not good caregivers to ourselves. We do not tend to
take time off to get a checkup, to do a cholesterol test, to assess
our own well-being. We often feel overwhelmed, over- worked, even sometimes
burned out. We feel guilty about ignoring what the patient demands of
us to provide good care and service, but we don't feel much concern
about our own health.
Our profession,
our physician culture, does not promote self-care. Our medical groups
often promote physicians who are obsessive workers to positions of prominence
as physician-leaders or administrators. They are respected by top administrators.
By promoting the overachievers and compulsive workers, we are, in effect,
saying that they are the models of behavior for all physicians. In this
day of population management of diabetic, asthmatic, and congestive
heart failure patients, are we ignoring a very important patient population--us?
Many of us do not promote evidence-based self-care for ourselves. In
a time when member access is of great importance, self-care often becomes
secondary. Do we have our priorities straight?
What Can We
Do to Help Ourselves?
Fellow
physicians and health care clinicians, before our medical groups sort
this out, take some time to do some self-care by going to see your own
doctor. Go through some of the evidence-based exams that we so vehemently
insist our patients do. I urge you also to remember your colleagues,
who may someday become your patients. Seek them out, ask them to come
in, establish that clinician-patient relationship, and care for them.
It's all right to add some pages to your medical records in the
fond memory of that olleague who has just died.
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TE, Williamson PR. Healthy approaches to physician stress. Arch Intern
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JR, Radcliffe T, Weisberger C, Richards M, Kelly J. Burnout among
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