It has been long established that the physicians have have not paid much attention to their own health in favor of their many professional and personal obligations. The culture of medicine encourage the belief that the physicians are never ill. Also, the doctors are typically very independent, competitive, and high achieving, and they often view attention to their own needs as a sign of weakness.
The strata of physician health is gaining attention; however , most research and interventions have concentrated on job stress, mental health and substance abuse. Little is known about preventive health and lifestyle behaviors among physicians and few programs have been established in these areas.
But now, the attitude have shifted to a positive side and increasing attention is being paid to physician health. The Royal College of Physicians and Surgeons of Canada have now considered self-care as a core competency, as physicians are expected to “demonstrate a commitment to physician health and sustainable practice.”
The Medical associations are beginning to recognize the demands of the profession and potential health risks involved, and several have forged programs to address the health care needs of their members. As numerous studies have established a link between the health behaviors of physicians and their interactions with patients, we are also recognizing that the health of physicians directly impacts the health of the larger population.
Currently, the focus of the research has been concentrated in three areas: work-related stress and burnout; mental health disorders such as depression and suicide; and substance abuse. In contrast, there has been less research to date into lifestyle behaviors and preventive health care among physicians. The largest and most comprehensive study of these issues to date was addressed in 2007 Physician Health Survey conducted by E. Frank and C. Segura, in conjunction with the Canadian Medical Association and several provincial organizations. Various aspects of physician health that warrant further attention such as nutrition, exercise, sleep and self-care has beeen brought forward in this and other studies. These issues affect almost every physician daily.
Not all doctors will have to tackle with substance abuse or depression, but all face the challenge of implementing healthy preventive habits into their busy lives. An increased cornerstone on healthy daily living among physicians could help prevent the progression to serious health issues, including mental health problems and addiction.
The Canadian Medical Protective Association (CMPA) has witnessed increasing efforts by regulatory authorities (Colleges), hospitals and other organizations to collect and use physicians' personal health information over the past several years. The hypothesis behind this effort is that it supports safer medical care.
As a general principle, the CMPA believes that:
'Physicians should not be required to pro forma disclose information in the absence of appropriate justification to Colleges, hospitals and other institutions concerning the status of their personal health. While recognizing the perceived benefit to the protection of patient safety, mandatory disclosure should not be used to trump individual privacy rights. The potential negative impact on a physician's self-worth and livelihood is so significant that a systematic approach is required. '
Below is the overview of the parameers like nutrition, exercise, sleep and self-care among physicians, drawing on research from both Canadian and international studies suggesting the possible future directions for both research and interventions:
The need for increased focus on healthy eating habits becomes more and more prominent as we face a growing obesity crisis. Like the rest of the population, physicains too could use some improvement in their diets.
The Canadian physicians revealed an average daily consumption of 4.8 servings of fruits and vegetables, with over half of physicians eating the minimum five recommended servings. Although this figure is inflated than in the general population, there is still considerable room for improvement. In 2009 and 2010, fruit and vegetable consumption in the general Canadian population declined for the first time from 48% to 43% , the significance of physicians as role models for proper nutrition was thus highlighted.
According to studies from both American and Canadian physicians, a strong personal-clinical relationship in many aspects of health care counseling such as nutrition, exercise, smoking and alcohol use has been depicted. Physicians who eat a healthy diet themselves are more likely to counsel their patients about the importance of proper nutrition and this counseling is more likely to be effective at triggering positive behavioral changes in patients.
The issue of workplace nutrition has recently received some attention as well. During working hours, physicians repeatedly report that they often do not eat or drink properly. Inadequate nutrition among the physicians had some impact on them at work.
According to follow up of a study, the researchers tried to identify barriers to proper workplace nutrition. The most frequently invoked barrier was lack of time due to excessive workloads and work scheduling (e.g. frequent lunchtime meetings). Lack of access to healthy food was cited by many physicians especially those working outside of typical business hours (when the hospital cafeteria is closed at night, for instance). Lack of healthy choices and inadequate food storage were also recognised as issues. Physicians elucidated barriers that reflect the culture of medicine and its lack of prioritization of personal wellness. Scanty food storage and lack of healthy choices were also identified as problems.
Thus,addressing the barriers to proper workplace nutrition should be the main concern for all health care organizations and independent practitioners. The policies promoting regular lunch breaks, increased healthy food choices at hospital cafeterias, extended hours of food services to accommodate nighttime staff and improved access to food storage areas are instances of simple changes that have the potential to provide significant benefits.
According to the Public Health Agency of Canada guidelines a minimum of 150 minutes of moderate-to-vigorous physical activity per week for adults aged 18-65, with up to 300 minutes for maximum health benefits.
Physicians get an average of 20 to 25 minutes per day of total exercise as depicted in a survey of Canadian physicians. In 2008, 48% of Canadians over the age of 20 self-report as being at least moderately active (150 minutes per week).
A study of medical students bought into focus that weekly exercise decreases throughout medical training, most likely due to increased workloads and long hospital shifts during the clinical years.
The physicians, patients and the health care system as a whole can be benefited by increasing activity levels among physicians. An excellent example of a simple program that encourages regular exercise in both physicians and patients and allows doctors to serve as healthy role models in their community was the BC’s Walk With Your Doc initiative, attended by over 100 doctors and 2000 patients around the province. To endorse exercise, simple changes in the workplace can be made like installing secure bike racks, having shower facilities on-site for those who exercise before work or during their lunch break and encouraging team entries to events such as local walk/runs.
The University of British Columbia’s Wellness Initiative Network, is a student wellness aimed at promoting student health and wellness through nutrition, physical activity, emotional health, and community involvement.
Sleep deprivation (both chronic and acute) arises due to long work hours, shift work and on-call duties. In atleast three days per week, half of general practitioners report sleep difficulties and almost two-thirds complain of exhaustion or sleepiness.
For this issue, a vast number of studies have focused on residents, as 80-hour work weeks (and longer) and shifts of up to 36 hours have traditionally made them the most at-risk group. About Two-thirds of American residents outlined sleeping less than 6 hours/night, with one in five sleeping less than 5 hours. To help deal with the problem of both acute and chronic sleep deprivation in residents, the limits on resident duty hours imposed by the American Accreditation Council for General Medical Education (which caps weekly hours at 80) and the recent legislation in Quebec capping shifts at 16 hours have been designed.
Chronic sleep deprivation in physicians and residents is petrifying as it has repeatedly been correlated with decreased cognitive performance, increased likelihood of medical error, and higher instances of self-injury such as needle sticks. Other studies have revealed that an average sleep deprivation - equivalent to about 18 hours without sleep—can be more unfit than being legally drunk.
Physicians are renowned bad patients. In many countries including England, Australia and Hong Kong, a large proportion of doctors engage in self-treatment as said by the researchers. In the past 5 years, one-third of Australian residents do not have a GP, and an equivalent proportion of young Irish doctors had not been to see a physician (either their own GP or a walk-in clinic).
Also, a large number of physicians admitted to self-prescribing medications, a practice that is considered unethical by all medical associations and has been prohibited by legislation in certain jurisdictions. Not all physicians are taking the recommended measures- was well explained as rates of compliance for screening tests like blood pressure measurement, mammography, Pap smears, cholesterol checks and prostate examination varied from 60% - 85% among Canadian physicians.
When faced with personal medical problems, the physicians commonly rely on denial and avoidance. More often, the physicians do not seek help, even though they may realize that they need it. A study conveyed that only 2% of Canadian doctors who were identified as depressed had sought treatment.
In the medical profession, it is believed that the physicians are never ill, and, if they do fall ill, they should silently work through their illness and put patient care above all else. Also, a physician's physical health is taken to be an indicator of their medical competence and may also feel pressure from both their patients and their colleagues to appear well.
To avoid the issue of self-prescribing and ensure that physicians are taking the recommended preventive screening measures, all physicians should have their own GP who can allocate regular, continual and effective care.
Healthy physicians as better role models
According to a new research, physician’s health influences how comfortable he or she is contributing healthy advice to patients — and that could motivate patients to adopt positive lifestyle changes. Jo Marie Reilly, MD, a family physician and associate professor at the Keck School of Medicine at the University of Southern California quoted “Practicing what we preach is important. Physicians are just more aware and better able to counsel patients if they take care of themselves.”
A survey of 1,000 primary care physicians depicted that those who exercised at least once a week or didn’t smoke were about twice as likely to recommend five lifestyle changes to patients with hypertension. Those changes include: eat a healthy diet, reduce salt intake, attain or maintain a healthy weight, limit alcohol use and exercise regularly.
Doctors who exercised regularly and maintained a healthy weight were most comfortable talking with patients about making healthy lifestyle choices as divulged in the fall 2010 issue of Preventive Cardiology.
Emphasis on hand hygiene
One of the primary ways to obstruct the spread of infection in hospitals is through washing hands properly but still nearly one-third of hospital workers are not washing their hands regularly.
As per the World Health Organization, good hand hygiene practices can help mitigate the spread of germs like C. difficile, a virulent stomach bug that causes diarrhea and may progress to bowel perforation, sepsis and even death.
For the prevention of hospital-acquired infections (HAIs) educating physicians about the prevention of these infections has not led to sustained augmentation. To upgrade handwashing behaviour previous interventions targeted at healthcare providers have demonstrated variable success.
Our healthcare system is partnering with private industry to execute technology that measures and tracks physician hand hygiene compliance on the basis of patient acceptance. Also, a technology plan has been devised at few places which alerts the patients when a hospital employee enters the patients' room. This technology along with computer-generated verbal reminders to the patient to ask the employee to clean their hands.