Physician heal thyself
One of my memories of my first week at medical school was the following two salutary lessons from a well-respected professor: 'You will do well to harm only 50% of those you treat," and "Doctors are several times more likely to die from heart disease, liver disease and suicide than the general population."
These were the days before audit, appraisal and reflective practice were part of our daily routine, but now I have data to prove that I do not harm 50% of my patients. Having refuted half of his lesson, I wonder whether his other assertion is still true.
Mortality amongst doctors has been studied for over a century. In 1886 Ogle noted that "mortality in doctors was extremely high" in particular from liver disease, which he attributed to excessive drinking. This seems to have remained true until the 1950s. A recent paper (2011) looked at standardised mortality of Norwegian doctors between 1960 and 2000. As the numbers of doctors who smoke have reduced dramatically in recent years, heart and lung disease are now less of a problem for doctors than the general population. We are generally good at living healthily and seeking help or screening when we should. We also have the financial resources to facilitate these things. Other health professionals, academics and people in similar socio-economic groups do equally as well. Overall our mortality is reducing in all categories except one - suicide, and women are more likely than men to die of this cause. Which potential factors can we hypothesise are associated to this frightening statistic?
Underlying personality trait of high achievers unable to cope with stagnation or failure? Increasing demands of the workplace for fewer tangible rewards? Or an increasingly litigious society that needs an individual to be at fault? There are probably many more factors and the issue is likely to be more complex than simply presented here. Despite increasing public awareness and some progress that has been made, the stigma surrounding mental health issues persists. I contend that we, as a profession, remain unable to admit when we are failing to cope with all that life throws at us. We still worry that the public and our colleagues will see us as unfit and that we will no longer match up to the Herculean ideal need to practise medicine. Is this true, or fair?
As St Valentine's Day approaches why not take 10 minutes to have a quiet cup of coffee with a colleague who has become slightly withdrawn or snappy recently and ask if everything is OK? We are excellent at looking after our patients; the evidence is that we need to look after each other better.
This month we have created new symptom leaflets for patients on breathlessness, chest pain and cough. We have also re-written our articles on radiotherapy, dry mouth and needlestick injury, following new guidance.