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Tuesday, 14 April 2020
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Healing the Healers –A Hope!

Primumn non cere –First; do no harm. The primordial guiding principle of health care; which is sadly neglected often; at least in its wholesome meaning of including health care workers themselves. We, who cater to alleviating the disorders of ease (dis-eases), tend to often forget how vulnerable we are to losing our own.

Since health care involves such a myriad group of workers in so many different settings it is difficult to quantitatively assess the actual damage to our own well being. Even so, it certainly continues to take a toll on doctors, nurses and the many other health assistants.

A study by IMA, though limited in its scope, highlights the gravity of the situation showing early age of mortality amongst doctors in contrast to average people. (1)This essay hopes to ask some questions about our own plight, in the quest to alleviate suffering.

Ever since we begin our training in anatomy, we slowly but surely are attuned to the morbid association of providing health care and disease. In this process, perhaps we take our own indisposition for granted. The first; and perhaps most difficult step, is to accept that we are indeed suffering.

As doctors, we tend to get driven with the aura of the of the repeated allegation by some of our patients – “how can you become an ill doctor?” The truth is that we are just as human as any other, with all the weakness and frailty included, perhaps even more so, due to our lifestyle.

As providers of health care, these terms are not easily acceptable to us for our own state of affairs, be it physical, mental or even spiritual. The reasons of neglect can be many, a busy schedule, hopes to improve our practice, to appear more capable to patients and colleagues, to spend more time in teaching or simply trying to juggle it all with family time.

Yet accepting that we do not know how poor our own state of health can become is essential to addressing the problem of disease amongst health care professionals. One of the greatest mirages which many of us have is that we know enough about health care and hence don’t need a consult or don’t need to follow advice to the letter – this has to change. As Socrates is supposed to have said, true wisdom is in knowing that we do not know.

Since we, especially doctors, love to quote scientific studies, it is surprising how very little exists about our own selves; or even about health care professionals in general. This in itself is clearly a sign of the denial highlighted above. Sadly, most of the studies are oriented around death, like the study by IMA in Kerala and Maharashtra (2) or the one denying early mortality by a US group back in 1997 (3).

What is clearly neglected is that health – and the deviation from a complete state of physical, mental and spiritual well being has many aspects beyond and more importantly before death. In some parts of the world, few great initiatives are being undertaken, highlighting this very problem.

Many recent works stress the importance of physician wellbeing as a whole and suggest ways to begin to solve these pressing issues. Sadly, most of these are not catering to the unique problems we face in developing nations. The Lancet articles and the methods adopted in Australasia referenced here are a valuable source to start the work in our own country, albeit needing great modifications for our specific challenges (4-6).

Health care providers need to first accept that we need help and that it must be both sought by ourselves and arranged by the various levels of management that we work with or under. Our own personal time, including family and social ties, should not be neglected, because just like other humans we are prone to extreme mental stress in this regards.

We should start at the beginning of our training, going back to internship and residency where the trend to teach that we compromise on our own time and sleep to serve patients has to change. While it is true that patients need service, it is equally true that so does every human, including health care workers.

If the policy makers do not have the commitment to increase spending on health, it is the care workers who will end up in burnout, and hence poor societal medical well being. It has to be stressed that the health of ladies is to be respected even more, if maternity leave is required, be it in internship or residency then it should be given with due arrangements made.

A surgeon if neglecting his own physical, risks having chronic back ache and even disc prolapse. Similarly, an EMS physician takes the risk of chronic depression, entwined as they are in morbid suffering. To think about these issues and actively do something about them is the need of the hour.

This is essential for a long term and fruitful work being provided for a sustained time than it would be by ailing professionals. Beginning at our own, we must have regular consultations to a general physician, though the system is not streamlined in our country.

Seeking off hand advice from colleagues can be often misleading, both for us and those around us. We should depend upon them as friends and build a social life, rather than make them a medical source to cry out in an emergency but not follow advice in routine cases.

This is a list as suggested by the Royal Australasian College of Physicians, though not easily reproducible in our setting, but should be attempted by us as health care professionals.

Ten ways to be a healthier physician:

Have your own general practitioner.
Avoid taking work home.
Establish a buffer-zone (time out) between work and home.
Take control of your work hours. The following are a few examples:
• Schedule breaks.
• Take days off.
• Strike a balance between the hours of paid work and the demands of your job.
• Put holidays in your diary months ahead and tell your family.
Manage your time by making realistic schedules and not over-committing yourself (at work or at home).
Manage your work environment. This may take time, new skills and lobbying for better work conditions.
Use your colleagues for support and maintain and work on relationships with your partner and friends.
Take time out for your own needs through such activities as relaxation, enjoying personal interests or pursuits and maybe spending time alone.
Do not feel guilty or “less of a doctor” for demanding a life balance.
Humour is therapeutic: surround yourself with fun and humour daily. (6)

A healthy work environment should be provided for by administrators of hospitals, including recreational and fitness facilities, along with ample time for the same. CMEs are not to be considered recreational adjuncts. Monetary issues, as always plague a developing nation like ours, this has to be sorted out in as practical a manner as possible.

This clearly needs great impetus from the government regulatory bodies, including the medical councils which can legally ensure appropriate remuneration at each level of health care being provided. Regular health checks and insurance-driven care can help relieve some of the mounting stress.

When health care professionals are ailing, the entire health system is bound to become inefficient and in turn would fail to deliver well-being to the society as a whole. This is essential amongst a people which already burdened with the many health and resource issues.

The responsibility of the same cannot be pinned to one group or even institutes, but every person part of the care providers, from workers to administrators to financers, must realize that it is in the best interests of all to ensure a healthy environment and capable lasting work-force. Aiming for anything short of the same, would result in failing to ensure the most basic process of health care – and result in doing harm.

References:

Written By – Dr Syed Faraaz Hussain, Consultant Eye Surgeon, Paediatric & Squint specialist.

MS Ophthalmology ( Nair H. Mum), MBBS ( KEMH -Mum), DNB, FPOS -USA, FICO -UK, FVRS (Surgical Retina – Nair H. Mum.) FCPS -Mum, DOMS -Mum.ICO –Sub-specialty Paediatric Ophthalmology & Strabismus FAICO Paediatric Ophthalmology & Strabismus –Delhi.

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Healing the Healers –A Hope!

Ten ways to be a healthier physician:

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