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Table of Contents
MUSINGS
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 433-434

Thwart embers before they become an inferno


Department of Clinical Hematology and Stem Cell Transplantation, Dayanand Medical College, Ludhiana, Punjab, India

Date of Submission14-May-2021
Date of Decision15-May-2021
Date of Acceptance16-May-2021
Date of Web Publication22-Jul-2021

Correspondence Address:
Suvir Singh
Department of Clinical Hematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_105_21

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How to cite this article:
Singh S, Sharma R. Thwart embers before they become an inferno. Cancer Res Stat Treat 2021;4:433-4

How to cite this URL:
Singh S, Sharma R. Thwart embers before they become an inferno. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:433-4. Available from: https://www.crstonline.com/text.asp?2021/4/3/433/322577



Recently, the medical profession is increasingly being viewed in a negative light. The combination of high expectations, strained resources, patient and family impatience, episodes of violence, and unending hours at work has made it one of the most stressful vocations. Amid this noise, the true meaning of being in medicine can sometimes be lost, and burnout rears its ugly head.

January 20, 2020: So much for new-year tidings. A 58-year-old neurologist and a 36-year-old gynecologist have suddenly had cardiac arrests, the former while delivering a guest lecture and the latter while finishing up a surgery. You receive the news as a WhatsApp message, the events not being significant enough to make the news.

To put that into perspective, let us look at someone who you have seen all too frequently while working at the hospital. Dr. A is a coveted figure for young students and residents to follow. He was an outstanding student of his class and had an impeccable academic record. Now, as the professor and head of the department of neurology, he is often seen as a role model for multitasking and time management. He successfully juggles clinic hours, research, and teaching. Just 38 years old, he is in the office at 8 a. m., and his work, with 350 publications and over 35,000 citations, speaks for itself. His area of interest is how inflammation affects the pathogenesis of aging and neurodegenerative diseases. However, it is always the darkest under the lamp, and his records and citations fail to address his rising blood pressure, which spikes up to 190/100 with each phone call from the intensive care unit and deadline alert on his computer. They also do not show his plasma inflammatory cytokine levels, each of which shoots up and increases his risk of dying from a stroke or a myocardial infarction.[1] Let us say that the risk for him is x per 1000 physicians.

Now, juxtapose the above story with the life of a doctor in India who is at a relatively lower level in the system. He/she is the best student with an impeccable record and a busy practice with daily clinics. The clinic often goes on for 3–4 h with more than 50 patients per day. There are thirty patients in the ward calling for attention. The doctor must take time out between patients and teach 15 students while having coffee, then break for 5 min at 3 p. m., run to eat something on a full bladder and run back to the ward. Oh, a subspecialization degree? Likely persuading general practitioners to refer patients, receive a phone call at 3 a. m. from someone who complains of “uneasiness.” A week later, the same patient ends up in the hospital with septic shock, and they blame the doctor for not advising them on time. Is the risk still x per 1000 or a higher multiple? There are data from surveys conducted by the Indian Medical Association, which show that doctors have a much lower life expectancy than the general population.[2] This does appear like something we knew was ominously lurking beneath the surface but were afraid to ask. What makes the medical profession so stressful to the point of reducing life expectancy?

The stress probably starts as early as 15 years of age and recurs when entering a specialization and subspecialization course. Competition forces one to learn the answers to multiple-choice questions without context (nephrology protocols, anyone?), for a 1:1000 chance of getting a medical seat. If lucky, this is followed by another hustle after 5 years and then again after 3 years. By now, your favorite “scholar” is about 35 years old, has a child, and is expected to deal with an increasingly litigious, volatile, and misinformed environment. With the exception of high-volume academic centers, “marketing” probably becomes a de facto side enterprise. The video camera footage of gangs of attendants thrashing the junior doctor on duty is the perfect storm for stress-related illnesses. However, this phenomenon does not seem to be unique to Indian doctors, as studies from the United States and the United Kingdom have documented higher rates of suicide among physicians than the general population.[3],[4] Some studies have reported suicide rates to be almost twice as high among physicians when compared to the general population.[5]

Would You Expect X To Be Higher If You Knew That Both The Physicians Reported Above Were Women?

Uncovering this entangled web can provide a number of noteworthy answers. It was noted in the 1920s that physicians usually lived longer than their brethren due to a “simpler life” and “the even tenor of their ways”.[6] An enlightening analysis of life expectancy over the past 4 centuries from the Netherlands (often seen as a country with low stress and high quality of life) showed that the increase in the life expectancy for physicians was much lower than that for visual artists and other prominent persons over the same period of time. The usual culprits, including irregular schedules, disturbed sleep, and emotional stress appeared to be the driving factors.[7] Add managed care, metric-based outcomes, online ratings for physicians, and services that distribute your phone numbers online to that list. As usual, those who suffer the most are most likely to be able to suggest or implement changes. Thus, the junior doctors who are not in a position to act today are in the enviable position of being mediators of change tomorrow. This makes it essential to mindfully weigh the above issues and note how they become the “modifiable” risk factors of today. For junior doctors, the following three practices could contribute significantly to reduce burnout and stress.

Downtime

In the era of cell phones and WhatsApp, it is not uncommon to receive the images of eyes, nails, and stool samples for a quick opinion. Not answering “urgent” queries on phone/WhatsApp should not be taken as an indicator of callousness. A patient requiring urgent attention should anyway be seen in the hospital. Laws prohibiting WhatsApp consultations are probably the first step in the right direction.

Timing

Most significant discussions regarding patients should occur in the daytime, with risks of sudden worsening and advance care plans being clearly documented, to avoid doing the same at 3 a. m. with new family members and a junior doctor. More often than not, patients are thankful for clearly stating and documenting the possible poor outcomes upfront.

Joys of work

We do not mind if something is tough if it is worth doing. A daily reminder of why we are in this field and why we do what we do would serve to alleviate a lot of these problems, hence treasure the good moments, the grateful smile, the tentative handshake, and the elimination of uncertainty.

In the end, the number of citations is not what matters. What matters is the happy and fulfilling moments you spend with your loved ones. As I write this, I cannot help but sneak a peek at Twitter, and it is full of news about the latest movie and the actress who fell off a chair. The two physicians who suddenly died are nowhere to be found.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ellins E, Halcox J, Donald A, Field B, Brydon L, Deanfield J, et al. Arterial stiffness and inflammatory response to psychophysiological stress. Brain Behav Immun 2008;22:941-8.  Back to cited text no. 1
    
2.
Pandey SK, Sharma V. Doctor, heal thyself: Addressing the shorter life expectancy of doctors in India. Indian J Ophthalmol 2019;67:1248-50.  Back to cited text no. 2
  [Full text]  
3.
Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: Data from the National Violent Death Reporting System. Gen Hosp Psychiatry 2013;35:45-9.  Back to cited text no. 3
    
4.
Hawton K, Clements A, Sakarovitch C, Simkin S, Deeks JJ. Suicide in doctors: A study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995. J Epidemiol Community Health 2001;55:296-300.  Back to cited text no. 4
    
5.
Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC Jr., et al. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med 2017;92:976-83.  Back to cited text no. 5
    
6.
Hill AB. on the average longevity of physicians. Br Med J 1925;1:754-5.  Back to cited text no. 6
    
7.
Van Poppel F, Bijwaard G, Van Lieburg M, Van Lieburg F, Hoekstra R, Verkade F. The life expectancy of medical professionals in the netherlands, sixteenth to twentieth centuries. Population 2016;71:619-40.  Back to cited text no. 7
    




 

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