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Physician Stress


Every now and then go away,
Have a little relaxation,
For when you come back to your work
Your judgement will be surer;
Since to remain constantly at work
Will cause you to lose power of judgement;
Go some distance away
Because the work appears smaller
And more of it can be taken in at a glance,
And lack of harmony or proportion
Is more readily seen.

This is what Leonardo de Vinci said about 500 years ago. This is one of my favourite quotes. I have used it before in my columns.

I hope you had a good summer and were able to get away for a while – to relax, to look back, and plan for the future.

I had a good summer. Recently, I made some work related sacrifices to have more time off for myself and for my family. Then I took three weeks off and took my family to Europe.

My wife Sabiya, and our travel agent, Jackie Kirk prepared a wonderful itinerary. And with the help of friends and family, we were able to book some nice hotels and see some nice places. We went to London, Oxford, Paris, Geneva, Venice, Florence, Pisa, Rome and Vatican City.

We travelled by Eurostar from London to Paris, and then by Rail Europe. It was a fascinating experience. Our children loved it and we all had a good time. If you want to take your time and see Europe then I recommend you do it by train. The weather was good and everything went according to plan. And the trains were always on time!

If making a living is hard work then trying to find time to look after oneself requires sacrifices and fair amount of effort. Nothing in life comes easy. There is a price to pay – depending on one’s priority.

A recent poll shows that 25 percent of Canadians work more than 40 hours a week. Most physicians are known to put in long hours. For physicians, there are many sources of stress. Physicians are supposed to be independent practitioners, but they are paid by the government and their practice is, in many ways, controlled by the government.

When patients are not happy then physicians are not happy. Physicians’ capacity to deliver good health care depends entirely on the government’s capacity to provide manpower, funding, equipment, infrastructure etc.

A recent survey shows that physicians are concerned about access and funding and are feeling stressed, says the Medical Post. A survey taken in Northern Lights health region shows that 57 percent of the doctors are dissatisfied, mostly due to stress.

The major sources of stress for physicians are:

-Insufficient medical facilities for patients
-Office details and paper work
-Administrative and committee work
-Problems with other physicians
-Therapy and patient related problems
-Personal finances

Stressed out physicians cannot provide their best to their patients. And physicians face the same sort of lifestyle and health problems as their patients. There are programs organized by Alberta Medical Association to help physicians combat stress. Some physicians do take advantage of this help.

Stress in life is not going to go away. Neither for physicians nor for the general public. But we have to learn to combat stress. Each day, I try to learn something about staying healthy to help myself, my family and my patients. Changing life long unhealthy habits requires time to think, plan and take action!

We can all do it, if we try!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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The World in Turmoil

A recent opinion poll says that Canadians are worried about their future. They do not feel as secure as they did one year ago.

Life is getting very depressing for many Canadians. How do you feel?

Summer is supposed to be one of the best times of the year. But this year, things don’t seem to be the same – or do I have a short memory? You know what I am talking about. We complained about the late snow and rain. Now we have the heat wave. Then there are mosquitoes. Their bites are itchy – they burn for days! That can be depressing.

But compared to the rest of the world, we are in heaven. The economy is booming. Crime rate is not as bad as other countries. There is no civil war – the one within the Liberal Party is not killing anyone. And most Canadians are enjoying the standard of living which some, in other parts of the world, can only dream of.

And look at the rest of the world!

The world at large continues to be in turmoil. The death and destruction in the Middle East, the Indian sub-continent and Northern Ireland continues. There are many other wars which kill thousands of people but never get reported.

AIDS is taking its toll in Africa and other places. Poverty, famine, floods, disease and deaths in thousands continue to plague the vast majority of the world.

Women and children continue to be kidnapped and murdered. Sex, violence and profanity continue to be glorified in music, movies and TV. The war against drugs and alcohol continues without any sign of success.

The big corporations continue to swindle the poor stock holders who trust their life’s savings on the basis of glorified but sometimes false reports of success. The same corporations dish out large sums of money to our politicians and the political parties. They keep the democracy alive! It’s all in the family! What can we teach our children about business and about their future careers?

Did I leave anything out? We do face some of these problems here as well. But everything is relative.

What about the millions of unspoken heroes who continue to battle unfairness in everyday life? What about their contribution to make this world a better place to live? Without them there would be no hope. One would feel less depressed if one would think about and follow the examples of these unsung heroes.

So there is hope. Every season comes to an end. Daylight comes whether we keep a wake-up alarm or not. In life certain things are going to be out of our control. But wonderful things can happen if we take care of what we can do in a positive way.

Sometime ago, my niece, Rehana, sent me an e-mail titled, “Control your destiny”. In part it said:

“Wonderful things can happen when we decide to be responsible for:
Everything we put into our mouths,
Everything we put into our minds,
And everything we put into our hearts”.

So, don’t worry, be happy. Do your bit and have a wonderful summer – don’t forget your mosquito repellent, sunscreen and a cold drink. This column will take a break for summer as well.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Oral Contraceptive Pill

There is good news about oral contraceptives, says an editorial in the New England Journal of Medicine (NEJM).

“The development of oral contraceptives stands as a major advance in women’s health in the past century. By virtue of their ability to prevent pregnancy in 99 percent of women who use them properly, oral contraceptives have revolutionized reproductive choices for women,” says the editorial.

How safe is the oral contraceptive, also known as “the pill”?

A study in 1986 did not show any association between oral contraceptive use and breast cancer. But ten years later, studies of oral contraceptive use showed that women had a slightly increased risk of breast cancer while on the pill. But there was no increase in the breast cancer rates 10 years after quitting the pill.

So, what’s the good news now?

A well-conducted, population-based study, published in the recent NEJM, shows no association between past or present use of oral contraceptives and breast cancer.

That indeed is very good news for women who are currently on the pill or who have been on the pill in the past.

And there is more good news in the NEJM!

Use of oral contraceptives reduces the risk of uterine cancer by 40 percent after 12 months of taking the pill. There is also a 40 percent reduction on the risk of ovarian cancer after as short a period as three to six months of use, and 10 or more years of use was associated with an 80 percent reduction in the risk of ovarian cancer.

But nothing is hundred percent safe in life. Use of the pill is associated with some side-effects in a small percentage of women. These are:

-Deep vein thrombosis (blood clot in the legs)
-Pulmonary embolism (blood clot in the lungs)
-Stroke
-Liver cancer
-Heart attack in women over 35 years of age who smoke

But for most women, the advantages of the pill out weigh disadvantages. Besides the benefits mentioned earlier, there are other advantages to using the pill:

-Greater regularity of menstrual cycle
-Reduced menstrual blood loss and hence prevention of anaemia
-Reduced incidence of painful periods

Today, despite the threat of AIDS, users of oral contraceptives outnumber condom users by two to one. There are approximately 100 million women world-wide who use the pill. And these women should be thankful to a nurse named Margaret Sanger. In 1914, Sanger defiantly championed women’s right to have sex without fear of pregnancy in “The Woman Rebel”.

Based in Brooklyn, Sanger spread the gospel of voluntary motherhood relentlessly, says the Life Millennium book on the 100 most important events and people of the past 1000 years. Her birth control clinics were raided by the police and in 1914 she also faced an obscenity charge which was later dropped.

In 1960, six years before Sanger’s death, the U.S. Food and Drug Administration approved the birth control pill. One of the developers of the pill, Dr. Gregory Pincus, dedicated his research to Sanger’s “pioneering resoluteness”. The pill was cheap, convenient and reliable. It instantly became popular with doctors and patients.

So where do we go from here?

Women’s right to have sex without fear of pregnancy has been established. The next challenge for the scientists is to develop a pill which will have no side-effects affecting the heart and the lungs.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Heat Wave and Heat Stroke

Hot days are here. Some like it hot. Others find it unbearable. But hot days can be dangerous. Especially during a heat wave.

What is a heat wave?

Three or more consecutive days during which the air temperature is more than 32.2 degrees Celsius. Because of the global warming, the intensity of the heat waves is expected to increase over the years to come.

What is a heat stroke?

“Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40 degrees Celsius and central nervous system dysfunction that results in delirium, convulsions, or coma”, says an article in the New England Journal of Medicine (NEJM).

Extreme heat can cause other minor to moderate ill effects called heat stress and heat exhaustion. If not controlled or prevented then these conditions can lead to heat stoke and eventually death.

Heat strokes can occur due to exposure to high environmental temperature or from strenuous exercise.

The NEJM article says that the most complications of heat stoke are those falling within the category of multiorgan-dysfunction syndrome. That means many systems of the body are affected – brain (encephalopathy), muscles (rhabdomyolysis), kidneys (acute renal failure), lungs (acute respiratory injury), blood (bleeding complications).

Who is prone to heat stroke?

Usually very young or elderly persons and in those who have no access to air conditioning, says the article. It is also common among persons with chronic mental disorders or heart and lung problems.

How can we prevent heat stroke?

Heat stroke can be prevented. Authors of the NEJM article propose the following actions to prevent heat stroke:

-acclimatize yourself to heat
-schedule outdoor activities during cooler times of the day
-reduce your level of physical activity
-drink additional water
-consume salty foods
-increase the amount of time you spend in air-conditioned environments.

We cannot change nature. But we can adapt to our environment and create conditions to protect ourselves.

Prevention is better than cure! Enjoy the summer and stay cool!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!