Physician Health Matters

Yes, physician health matters because physicians are a valuable human resource.

Few days ago, I was in Ottawa attending 2006 International Conference on Physician Health. It was organized by the Canadian Medical Association (CMA) and the American Medical Association (AMA). The conference was attended by delegates from Canada, U.S.A., Europe, Australia, New Zealand and many other parts of the world.

This year’s conference was 18th in the series since its inception in 1975. This year’s theme was: Physician health matters: preserving a valuable human resource.

The delegates at the conference heard about the latest research on physician health, about new skills to survive and thrive in their career and learned about the progress that is being made around the world to protect the health of physicians.

The organizers of the conference say that by raising physician health issues at an international policy level, the conference seeks to promote a healthier culture of medicine and decrease the stigmata associated with the physician ill health, thereby decreasing barriers to physicians seeking timely personal care.

In 2003, a survey conducted by the CMA found that 46 per cent of Canadian physicians were in an advanced stage of burnout. Physicians feel they have to work harder and longer hours because there is a shortage of medical manpower. With the information overload there is a significant pressure on physicians to satisfy the public and there is constant political battle within our health care system to obtain fair share of resources to provide good patient care. All these factors do affect physicians’ personal and mental health and their capacity to deliver good patient care.

In order to help physicians understand the importance of looking after their own health, CMA set up a Centre for Physician Health and Well-being (cma.ca/well-being). Since then every province in Canada has established programs to help physicians and their families cope with stresses of work and encouraging healthy behaviours within the physician population as a whole.

At the conference, I was pleased to learn that every physician in Canada has access to a physician health program. In Alberta, it is called Alberta Physician and Family Support Program. The program has a toll-free number and a physician or a family member can call this number for help 24-hours-a-day.
As we know, prevention is better than cure. In the last few years, medical students, interns and residents have been in the driving seat promoting ideas on physician health and well-being. They are educating themselves at an early stage of their professional life to look after themselves and their families. They have learnt to reduce the hours they work, they have learnt to say “no” when they are tired and they have learnt to balance their lives.

I belong to a foolish generation of old doctors who took pride in working round the clock. Readers of my column and those who have read my book, A Doctor’s Journey, are well aware of my trials and tribulations with my own health. I learnt my lesson too late. In the last four years I have tried to change my practice and find a better balance in life.

It is hard to break old habits. After all work is a kind of addiction. It takes about one to two years to “detoxify” oneself. During this process one needs an understanding health-care administration, understanding colleagues, good friends, and a devoted family. Count yourself lucky if you get all four groups rooting for you during your down time.

Remember, as one door closes, another one always opens. So be brave doctor, do not forget to heal thyself first.

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Doctor, Heal Thyself First

Well, I am home now. I have been grounded by my cardiologist. I have to stay off work for two weeks and then get back to normal activities slowly.

If you read my column last week, you will recall that I was suddenly taken ill and admitted to the intensive care unit of the Medicine Hat Regional Hospital (MHRH). I went there on a Tuesday. I was diagnosed with unstable angina. On Thursday, I was flown by air ambulance to Foothills Hospital (FHH) in Calgary.

Unstable angina is a condition in which chest pain occurs at rest or minimal activity because coronary vessels are narrow and the blood supply to the heart muscle is compromised. But the heart muscle is not damaged as it would have happened if I had a heart attack.

Within an hour or two of arriving at FHH, I underwent coronary angiography. This is an imaging technique in which X-ray pictures are taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. My angiogram showed two areas of narrowing in the right coronary artery. Immediate angioplasties and insertion of two stents were carried out to keep the blood flow to the heart.

Angioplasty is carried out by inserting a balloon-tipped catheter (thin tube) in the diseased narrowed blood vessel. The balloon stretches the blood vessel improving blood flow through it. A stent is a mesh of thin metal which helps keep the blood vessel open.

On Thursday night I was kept on Unit 103B of the FHH for close observation to monitor for any complications like chest pain or bleeding from the groin where the catheter was inserted. My stay was uneventful. Next day I was transferred to Unit 4W substation at the MHRH for more observation and blood tests. I was discharged on Saturday.

I was lucky that I did not have a heart attack or a stroke. I was fortunate to have everything done in five days. In Calgary, within 24 hours, I was seen and taken care of by four cardiologists. The staff in the angiogram room, Unit 103B (FHH) and 4W substation (MHRH) and paramedics in Medicine Hat and Calgary took excellent care of me. I am grateful to them and other health care workers who do an excellent job under difficult circumstances.

What do I have to worry about now?

It is important to remember that coronary angioplasty and insertion of a stent is not a cure for coronary artery disease (CAD). Research shows that narrowing in the coronary artery will recur within six months in one out of five people who have had coronary angioplasty. My aim will be to prevent this from happening.

How can I do that?

I should try and control the process called atherosclerosis. Athero in Greek means paste and sclerosis means hardening. In atherosclerosis, there is a deposit of fatty substances, cholesterol and other substances to form a plaque which makes the blood vessel narrow. It is usually a slow, complex disease that typically starts in childhood and often progresses when people grow older. Like arthritis, it is a progressive disease.

The underlying risk factors for atherosclerosis are: family history of heart disease, high bad cholesterol (LDL), exposure to tobacco smoke, high blood pressure, diabetes mellitus, obesity and physical inactivity. The only risk factor I have is bad genes. I cannot change that. My LDL is within normal range but my cardiologist wants me to reduce it further. This can only be done with pills. I am not obese but I can afford to lose some weight. Otherwise, I don’t have other risk factors.

It is hard to predict the future. I am getting back to normal slowly. I have received many messages of good wishes and that has helped in the recovery process. Staying at home means I have more quality time with my family. I am enjoying that. See you in couple of weeks.

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Musings from an ICU Bed

I am sitting in the intensive care unit (ICU) of the Medicine Hat Regional Hospital and feeling sorry for myself. I am not here as a doctor but as a patient. An impatient patient!

The other day I was driving to work and felt unwell. I reached my office and felt my condition getting worse. So I turned back and went straight to the hospital emergency department. I was stabilized and then admitted to ICU. The attention and care I have received from the wonderful doctors, nurses and other health care workers has been outstanding.

You see, I have been under the weather for the last couple of weeks. But like a typical male-patient and a doctor-patient, I was treating myself and postponing my visit to my family physician as long as I could. And that is a stupid thing to do.

In some of my recent columns, I have mentioned 2005 being a good year for me in many ways. I was lucky to have many wonderful things happen to me. I also wrote how I try to adhere to the principles of ELMOSS (exercise, laughter, meditation, organic healthy food, stress relief and no smoking). And my plan was to continue to adhere to these principles for 2006.

But somebody had different plans for me. As I drove to work that day, I realized I needed help. I could not postpone it anymore.

So here I am, lying on an ICU bed with oxygen prongs in my nostrils. Millions of cables running from my hairy chest (ouch!) running to the cardiac monitor. An intravenous catheter is in my right wrist. A name tag and allergy tag on my left wrist.

My vital signs are monitored every two hours. Thank goodness they don’t use rectal thermometers anymore. And not every patient admitted to the hospital needs an enema. That is called scientific progress.

My smiling nurses and physicians keep me stable and amused with their care and visits. My wife and children are concerned but very supportive and patient. Their visits are a great strength to me.

But I still feel miserable and sorry for myself. The invincible Dr. B is in the hospital again! I had to cancel my office and several procedures for the rest of the week. Some patients had gone through that ghastly bowel prep for their colon check in my office that day. They will have to drink the stuff again. I had to cancel several vasectomies for that week. These young fellows take time off and get themselves psyched up for the procedure. Now they will have to go through all that again. Several patients were to see me for consultations and follow-up. They will have to wait little longer.

But if I don’t get better now then I may not see any patients ever. “So doctor, heal thyself first,” says my doctor. Here I am trying to be a model patient. Trying to enjoy the wonderful care I am getting. I am also waiting for Calgary to phone as my internist wants me to have more tests and treatment which is available in Calgary. He has been making phone calls and we hope to hear from Calgary as soon as a bed is available.

I hope to be back at work very soon. Probably by the time you read this column I will be working. I hope to be back on my ELMOSS schedule. I hope to be optimistic again about 2006. I will consider this episode as a hiccup in my pursuit of happy and healthy life. Let’s think positive. Life could worse.

Let me end by thanking all the nurses, doctors and other health care workers who took care of me in the emergency department and ICU. I greatly admire the people who work in the Medicine Hat Regional Hospital. They do a good job. Keep it up. And now that I have shared my feelings and experience with you, I feel better already. Sharing is caring.

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

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!