Physician, Heal Thyself

English Lexicographer Samuel Johnson had said that ‘health is the basis of all social virtues. We can no longer be useful when we are not well’. This applies to everyone including the physician.

The training in the medical sciences has given us the capacity to accept advances in the pathogenesis, diagnosis and management of various maladies afflicting the mankind, and to incorporate new information and technologies into our practice. The physician must be healthy to cope with the new challenges and to adapt to change. A physician who is not keeping good health finds it difficult to practice medicine with reasonable skill and safety. Such a situation may arise because of physical disability, mental illness, ageing, stress, emotional problems, excessive use of drugs including alcohol and sexual misconduct.¹

The practitioner of healing ‘must be a friend, philosopher, well wisher and guide of the patient and the family under his care’. But an impaired physician is unable to perform such obligations and he is a sick person needing counseling and treatment.²

Man is born to be healthy and the laws of nature tend to make him healthy. That’s why English poet William Hall said ‘take care of your health, you have no right to neglect it and thus become a burden to yourself and perhaps to others’. The physician like any other individual must have a natural feeling of well being, contentment, peace within and harmony.³ He has a professional duty and commitment. Sickness prevents him to perform his duty of providing health to the sick.

Talbott and colleagues after reviewing the cases of 1000 physicians in a national study in United States have considered the following factors to play a role in the development of physician’s impairment: 1) genetic predisposition and environment exposure; 2) stress and poor coping skills; 3) lack of education regarding the various types of impairment; 4) absence of effective preventive and control strategies, and 5) drug availability in the context of a permissive professional and social environment and denial.⁴

The physical and mental impairment that is developing in the physician must be initiated to arrest the progress of the disease and deterioration and rehabilitate him to an active professional life.

The work and lifestyles are taking a heavy toll on the health of physicians and it is rendering them candidates for many diseases. A study carried out at Chennai, India on the health status of 2499 (878 men and 621 women) physicians aged 25 to 55 years from urban and semiurban areas of several states in India has rung an alarm bell.⁵ The young physicians who are in the profession for more than 5 years have a higher prevalence of hypertension, impaired glucose tolerance, abdominal obesity and raised cholesterol levels than the general population of a similar age group and socio-economic status.

An earlier study in North India had shown a higher prevalence of coronary risk factors among physicians.⁶ It is a paradox that the physicians have a high risk of lifestyle diseases though they have among the highest levels of awareness of such diseases, and are treating their patients for the same. Lack of time, sedentary lifestyle and higher socio-economic status could contribute for the increased risk.

The studies carried out in developed countries such as USA, UK, Australia and New Zealand have shown that doctors do not take good care of their own health^7-9 and the Indian studies agree with the global findings.

The physicians are now facing numerous challenges in balancing personal and professional lives. Often the altruistic tendencies could result in physician putting their profession before their personal needs.¹⁰

Physicians are not taking good care of their own health and are to be motivated to practice good health care habits that they advocate to their patients. A physician suffering from impairment must be made to understand the reality of the situation and its consequences. He/she must be motivated to undergo treatment. Colleagues and members of the family form a team in carrying out the treatment modality. There is a need to educate and continuously monitor physician’s health and adapt strategies to reduce health risk.

The persons whom the physician loves and respects play a leading role in the management. The physician may exhibit anger, defensiveness, sadness or shame on knowing that he is not well. Prevention is better than early diagnosis and management.

Physician must remember the importance of balancing professional life with hobbies, exercise, good nutrition and family and spiritual support. Family and friends offer him/her the necessary support during his/her wellness or illness. When he is ill, he has to undergo treatment including psychotherapy where indicated.

The working conditions of the institution play an important role. The physician must feel satisfaction with the job. Excess work load, extensive working hours, verbal abuse and harassment will have deleterious effect on the health.

Stressful conditions lead to stress impairment syndrome. Then the physician is unable to cope with long working hours, to keep abreast with the new developments in medicine or to manage the conflicts of professional and family life. There will be an inability for relaxation, disruption of sleep patterns, erosion of interpersonal relationships and impaired clinical judgment. All these factors affect the patient care and the physician exhibits inappropriate or eccentric behavior. It interferes with his professional work and he loses the insight into the patient’s illness and fails to provide quality health care.

The physician has to be well to carry out his/her obligations to the society, and to remove diseases and assure life. The physician who follows healthy lifestyle can effectively motivate his patients follow similar practice.

The current COVID-19 pandemic has taught us the lessons of taking care of one’s health by following the advice of wearing the mask, keeping social distance and sanitizing the hands frequently. In addition, they must take the vaccine. Any lapse in these preventive procedures, will lead to the person contacting the infection and face its consequences. We have seen many physicians succumbing during the two waves of the disease.