The health of health professionals or How to burn out while doing everything right

So you may or may not have noticed that I have not been blogging. As it turns out, being a hospital resident is a bit more than just a full time job (the understatement of the century). Besides, being on a busy surgical team played right into my ADHD tendencies: brief ward rounds (“Morning, how is your pain? Have you opened your bowels? Any nausea or vomiting? You are doing great, see you tomorrow morning”) and suddenly anything over 140 characters of writing seems impossibly long.  But now that I am back on the ward and have to ACTUALLY TALK to patients, I am finding my brain starting to slow down from the hectic pace of the last few months.

Something that I have become increasingly acquainted with in the last few months is the health habits and the lifestyle of my esteemed colleagues and other health professionals. And let me tell you health has nothing to do with  it.

Educating people on healthy diet and lifestyle choice is widely considered a panacea for the today’s obesity woes. Those poor Mums buying McCrap for their muffin-topped offspring just don’t know that this is not particularly good for them. Let’s horrify them with the consequences of not eating broccoli and the world will be right again, yes?

The same logic will tell you that healthcare professionals should be the healthiest people on the planet, right? The combination of a higher socio-economic status and specific education in disease prevention should almost guarantee them svelte figures, long life and no chronic disease struggles.

Health professionals KNOW better and they can AFFORD better. Is that the reality?

Here are real-life conversations I have had in the hospital with doctors, nurses, physios, etc. in the last few months:

– I am always tired, every day, I don’t know what’s wrong with me. I don’t even feel like training today. – How often do you train? – (puzzled look) Every day.

– (in a hospital cafeteria) I’ll have a banana bread and a skim extra large latte. No, no butter of course.

– I am doing a double shift today. It’s a shame the cafeteria closes at 6.30pm. I really need a few more coffees to last me to midnight.

– (11pm) Oooh, l just can’t say no to baked treats on a night shift.

– I really need to exercise more. I tried going to the gym after my night shift at 7am but I just can’t make myself do it. I am so naughty.

– I don’t know why I am always so cold. I might ask to have my croissant warmed up.

-I was good yesterday and had a salad for lunch and salmon for dinner. But for some reason I really crave sweets today. I’ll just have this TimTam and then I can always go for a run after work.

– Whose birthday cake is it? I thought Ann was yesterday? Ah, that was Michelle’s. Yum. Did I tell you that I started buying Flora ProActive for my husband because his cholesterol is through the roof? And he still has bacon and eggs for breakfast!

– I always put exercise as my number one priority before sleep. After I finish my night shift at 7am, I have a 2 hour nap and then go to the gym. If I don’t go to the gym I feel lethargic and cranky. Although recently I went to my GP complaining of increased breathlessness. Turns out I am really anaemic.

(This last conversation left me with my jaw dropped to the ground. And probably served as the catalyst to writing this blog post. Thank you, Sarah. )

Get your butt up and go for a run, you lazy sod. (Julia Fullerton-Batten/Getty Images)

Probably a repeat of conversations you hear at any office, workplace, any water cooler and tearoom. What strikes me every day,  apart from the obvious natural fat-phobia (which is nothing new), is the ridiculous amount pressure these people put themselves under.

It is understandable that seeing sick patients riddled with chronic disease makes us determined NOT to end up like them. We are more aware (=more paranoid?). Most health professionals go about it by reducing junk food. Sure, you find lots of “healthy” baked treats on the wards, homemade cakes making a resurgence in light of Masterchef and everyone is suddenly a gourmand. But to be fair, you won’t find many doctors in a line at KFC.

The next thing to be screwed up tight is exercise. And when health professionals get into it, they don’t hold back. Triathlons, marathons, bike rides before dawn, fitness classes at 6am. Exercise has become part of our healthy identity. The number of hours in the gym is the matter of competition, sports injuries are a badge of honour.

I don’t know at what point we have decided that exercise is going to solve our problems? Our lack of sleep, horrific work hours, shift work, mental stress, lack of sunlight, excess stimulants, daily exposure to pathogens, indoor lifestyle and, frequently, disconnect from nature and natural environment. Is exercise a cure-all or is it really a punishment that we impose on ourselves for failure to address other issues?

Hey, let’s face it. Exercise can (and should) be fun: cycling, yoga, surfing, bushwalking, kayaking, weights, rock climbing, having sex. If you need to guilt trip your way into any of those, maybe some other part of the equation is missing.

On the big scale of HEALTH vs DISEASE, where your ideal food intake is on one side and your crappy busy indoor work lifestyle is on the other, where do you think daily exercise is going to go? Will it add to your positive balance and compensate for that last 18 hr shift? Yes? Wrong answer.

Ignoring the pressures of work and lifestyle or hoping to willpower your way through them doesn’t work. Period. Even with the best nutrition strategy (no, a low fat muffin isn’t one of them) and the best intention of maintaining physical activity, you are always playing catch up unless you recognize all other areas of your life that have the ability to derail you.

 

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25 thoughts on “The health of health professionals or How to burn out while doing everything right

  1. Nailed it again Anastasia. Great to see you back. Have a great weekend.

    Adrian and Rona

    • I start feeling cold at around 9pm. There is nothing you can do, it’s that shivering deep inside that no amount of clothes can save you from. It’s the same feeling that makes you want coffee and sweets.

  2. Welcome back Anastasia!
    Your schedule is punishing, and I guess to be honest it’s unsustainable in the long term. We are really finding out how stress and wrecked routines affect health. My better half is on 4 weeks on and 4 weeks off, and we have found that it has to be managed proactively to keep a lid on stress and weight gain. Add travel, and time differences in the mix, and it’s a real challenge. I really think people are clueless about stress and fatigue, thinking that it is the new normal. It’s scary. Hang in there this too will pass,
    Cheers

    • Thanks Heather. It’s actually rare that people recognize these clues. Sounds like you guys are keeping on top of it. And you are right, it is hard to rise above the crowd and say: “No, this is not normal. I am not supposed to feel that way”.

  3. Good to see you back! Conversations like those from medical professionals especially make me wonder at what point the medical profession will take its knowledge about diet and sleep and exercise and how the lack of any of them can be harmful enough to any professional’s mental clarity and give doctors humane-enough schedules to be able to properly function (emergencies aside).

    • When this issue is raised, it is actually the doctors themselves that fight the reduction in their work hours. Deeply ironic.

  4. Loved this post! I get lunch in the Med School cafe regularly and am always shocked by two things. One, the nearly complete lack of healthy food available – normally my friend and I fight over the last salad to pair with our sardines. Two, the complete garbage that is on the trays of all the med students, nurses, and doctors that eat there. How will things ever change if the most highly educated and financially stable of us won’t even choose to eat healthily? A sad situation indeed.

    • But Laura, they are skinny! That’s all that matters (sarcasm font). If you remain skinny it apparently doesn’t matter what garbage you put your mouth.

      • If you remain skinny it apparently doesn’t matter what garbage you put your mouth.

        Such a sad dislike for this statement, but unsurprising. Expands beyond doctors circles too 😦

        Awesome post, great to have you back blogging!

  5. Ahmen! I work with a studying-to-be MD (it’s his side job here). He’s overweight, and always talking about eating healthy trying to lose it. Yet all the baked goods he eats…yuck! I tell him time and time again, but he just doesn’t get it. And then I tell him that fat is around 60% of my daily caloric intake, and he goes bonkers. And I’m friggin ripped in shape. haha

  6. When I came back to my Zumba class after almost 2 years of absence (at first I had to address Plantar Fasciitis , then I twisted my ankle quite badly), there were new faces, but some veterans were present as well. They were happy to great me, and commented on me looking thinner. I told I was really slowed down by my injuries, and only walked, rollerbladed once in a while, did yoga and tai-chi. “Then how did you loose all that weight, did you eat?!”- they cried. I told them that in a process I found out that the diet was more important than exercise, I ate well till not being hungry, but avoided all grains, starches and sugars. They looked at me like I was a creature from some different universe. It would never sink, I am afraid. Quite few of them looked heavier.

    • Hi Galina. Yes, you are right, people overestimate the effect that exercise has on weight management. While it is undoubtedly health-promoting, it will not undo your diet choices, especially if those are low-fat, inflammatory refined rubbish.

  7. Anastasia, you are so spot on with this post. it is so hard to watch. During my last term, I had a colleague who had trochanteric bursitis from iron man training, along with asthma requiring the use of puffers during our morning meetings in orthopaedics. I can’t say very much about nutrition, because conventional wisdom has them hooked. But it disturbed me to watch her eating her omega 6 rich fries (rather a frequent dietary choice) and having a morning coffee and muffins (picked up from the espresso drive through on the way to work. I didn’t know that about the training for an iron man competition. An email was mentioned about the top 10 mistakes that endurance athletes make and I said well the top mistake would be that they are doing endurance training. That didn’t go down very well. (I will probably just send a copy of Mark Sisson’s projected book on endurance training. If I had had time, I would have written one myself, but Mark is so good at what he does I will be happy to buy lots of copies)

    But being a resident is screwing up my health to such an extent that I may need to resign. Myself I have a subacromial bursitis from 11 to 15 hour days of writing in patient charts and computing at work station that had appalling ergonomics. I get dermatitis from the hospital supplied hand washes (especially the one with triclosan). I have headaches from the “air fresheners” that seem to be everywhere.

    As it is, going to work is like going to war. I bring my own water and all my own totally paleo food to work (when I make the education sessions the drug reps with their unhealthy free lunches find me incredibly annoying). I never have caffeine. (one of my colleagues offered to make me a coffee and I said thanks but I only drink water at work. He said that that was a good idea then went on to tell me that he and another intern had talked about becoming constipated from not having the time to drink enough water) My paleo lifestyle is probably the only thing that gives me the stamina to function over an intense 8 hour shift on call after hours, as during an 8 hour shift I often do not have time to eat, I often don’t have time to drink (which I am particularly appalled about). But being strictly paleo I never get hungry as I have nice consistent blood sugars and no insulin surges. Which is good because I seldom have time to have meal breaks (if I take one I’ll be going home even later)

    I do everything I know from my self-directed learning to manage my stress levels: rhodiola rosea, siberian ginseng, korean ginseng and withania somnifera. I take one of the exceptionally good brands of cod liver oil, magnesium and a B complex with folate rather than folic acid. (there are other things that I do but wont bore you with)

    I wish I had more time to spend doing yoga and taking my dog for a walk, but with the hours I work I actually have to prioritize sleep over exercise. I probably have enough incidental exercise from using the stairs and running around the hospital, but I am aware that exercise outside is so much better for your brain.

    And despite all the effort I put into my health, I do not know how much longer I can persist with the demands being placed on me.

    But its no surprise that our colleagues don’t know how to look after themselves. Have you seen this: http://orthomolecular.org/resources/omns/v08n23.shtml

    Thank you for your post. It made me feel much less isolated.

    • Sorry to hear you are struggling. I think being self-aware actually makes it harder to tolerate our horrific schedules, lack of sleep, being inside and psychological stress because, unlike our colleagues, we realise that this is not a normal state for our bodies to be in. Sounds like you are doing the best you can to ride it out and maintain your resiliency. How long have you got in residency? Reminding myself that this is a temporary situation makes it easier for me to cope. And when I have time off I completely switch off. It is one of the reasons why I don’t blog as much. I just can’t justify spending my time off on a computer blogging or researching when I can be outside in nature unwinding and getting myself ready to do it all over again.
      Hang in there 🙂

  8. My internship was fine. I wasn’t overworked and my evenings on call were manageable as I looked after 3 medical wards, rehab and palliative care. If I wasn’t busy I would plow through some of the neverending pile of discharge summaries that awaited the day team. The only things that were annoying were being put on call on my first day in the hospital as I was likely to become lost! and going from weekend night shifts to PGPPP orientation on the Monday morning. We had a lovely emergency department schedule and you would be on remote call on a day off. As ED interns we had 6 hours of education every week in a group in the education centre.

    I was able to go to ALL the education sessions available to me including 2-3 hour workshops on things like infectious diseases, paediatric emergencies and obstetric emergencies.

    I am now in a different hospital. If I am in emergency I have to be on remote call overnight after working a 10 hour shift. If I am on call in the evenings I am covering 8 wards across medicine, surgery, coronary care, rehab, palliative care and paediatrics on my own. This work load is dangerous as I can’t review four patients with chest pain all at the same time.

    When I was working in orthopaedics I worked 10-15 hour days and had one stint where I had to work 11 days in a row. I have applied for GP training and according to the RTP I have now accumulated enough hospital terms to satisfy their requirements. Two of my own specialists have advised me to resign and take up surgical assisting for work (which I actually quite enjoy- not that I was able to do any during the orthopaedics term). I am lucky that I have two other professional qualifications to fall back on. My acupuncturist would love me to go and work from his rooms consulting on nutritional and environmental medicine, but I don’t know if I am allowed to do that. I think that without a GP fellowship, we can consult in nutritional medicine but as naturopaths (and then our patients can only access rebates from private health funds rather than medicare). But apparently there are so many children where we live whose parents are desperate to consult an ACNEM doctor and the closest one has closed his books to new patients. I am still exploring other medical work options, such as telling them that I will only work part time and if they don’t like it I am happy to resign and just hunting around for a nice locum position somewhere. But I am still trying to figure it out. I am actually feeling a lot better tonight knowing that resignation is an option.
    I just hope that you are having a better time than I have been.

    • Oh syrinx, hang in there, keep your options open. Have you thought about moving out to a regional area? We are so desperate for quality medical professionals in the bush, and someone with a paleo perspective would be gold.
      Cheers

  9. Hi Anatasia I appreciate this post. I’m a nurse in a long term care facility and it’s the most unhealthy environment on the planet. I could go on and on about the quality of the food but the stress from patient care, understaffing,etc. trumps food to me. I think stress is the number one factor of getting sick, diseases,etc.

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