| Dec 12, 2019

This is the ultimate proof that we need a new system of healthcare

Doctors who don’t know how to deal with their own health are a sign that our entire healthcare system is on the ropes. Here’s how we can take back wellness.
Healthcare system

Deck: Doctors who don’t know how to deal with their own health are a sign that our entire healthcare system is on the ropes. Here’s how we can take back wellness. 

Picture this: you walk into the office of a financial advisor who you’ve just hired to answer your questions about short-term budgeting and long-term investments. Expecting someone in a suit, sitting behind a mahogany desk, what you find instead is a disheveled man in an office barren of furniture; papers are loosely scattered on the floor.

You try to listen as he makes his introduction, but you can’t help but be distracted by the holes in his t-shirt and his untrimmed beard. “I’m so sorry to interrupt,” you say, cutting him off, “but where is your desk? And don’t you have any nicer clothes to wear to work?”

Shockingly, he says he can’t afford those things. “But you’re my financial advisor,” you object, “and I’m supposed to trust your ability to manage money.” He then politely explains that you’re just a victim of a common misconception — his personal financial situation is nothing out of the ordinary; in fact, most financial advisors are totally broke.

Hopefully this scenario seems ludicrous. It’s meant to. What’s even more ludicrous is that while the finance industry may not have this problem, the field of healthcare does. It’s overwhelmingly common for the very professionals whose job it is to keep us healthy to suffer from poor health themselves. Unlike the fictional scenario above, however, the fact that healthcare professionals aren’t well won’t always be obvious, and in most cases they certainly won’t tell you.

The biggest indicator that doctors are poor role models for wellness can be summed up in one word: burnout. Despite its lack of a fancy medical name, burnout is, in fact, an identifiable condition. It is diagnosed on the basis of the presence of three specific criteria: emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. (If you’re unfamiliar with depersonalization, it’s an experience typically described as “mental or emotional detachment from one’s self,” and is thought to be a temporary reaction to stress, trauma, or anxiety.)

Not only is burnout very real, but it’s becoming a problem of epidemic proportions in the medical community. The World Health Organization agrees, having officially recognized burnout as a mental health concern for employees worldwide.

How common is burnout?

DXY, a popular social media platform among Chinese physicians, recently reported that two out of three doctors in China experienced burnout in 2018 — that’s a full 66 percent of the physician community. Healthcare company Merrit Hawkins conducted a survey on the subject in the U.S., finding that 78 percent of American doctors reported experiencing burnout. In the U.K., the trend continues to worsen, with 80 percent of British doctors found to be at “high” or “very high” risk of burnout, according to the British Medical Association.

An international study conducted jointly by researchers from Canada and Jamaica found burnout to be a “common problem” among primary care physicians. The authors also explored correlations between symptoms of burnout and doctors’ personality traits. It turns out that the more neurotic, agreeable, and conscientious doctors were, the higher their risk of experiencing burnout.

This is alarming, considering we want our healthcare providers to be conscientious and perfectionistic. In a way, these findings suggest that the harder doctors try to be good at their job, the less healthy they become — and make no mistake, burnout is seriously unhealthy.

A study of public health in Finland found that people with symptoms of burnout had a 10 percent greater likelihood of experiencing physical illness — a heightened risk that could not be explained by demographic or behavioral differences. The same study determined that women with burnout were more likely to suffer from musculoskeletal disease, while men with burnout were more likely to develop cardiovascular disease. And the WHO names cardiovascular disease as the number one cause of death worldwide.

In addition to burnout, physicians experience a high rate of other mental illnesses. For example, certain studies show that burnout is often coupled with depression or anxiety. Regardless, the frightening statistics on the mental health of healthcare providers is another red flag that something is wrong with the way we understand wellness.

According to one survey, for instance, 85 percent of doctors have struggled with mental illness. A meta-analysis of mental health surveys worldwide, however, revealed that only 29 percent of the general population experiences mental illness at some point in their lifetime. Differences in survey methods and criteria could have contributed to the gap between these numbers, but it’s difficult to imagine that they could account for the entirety of such a massive chasm.

Along with mental illness comes its darkest shadow: suicide. Sadly, the rate of death by suicide, as well as number of attempts, is much higher among healthcare providers than it is among members of most other professions.

How do we account for these disturbing statistics? The truth is healthcare providers do have difficult jobs, laden with stress and responsibility. And around 25 percent of physicians work between 60-80 hours per week, which is significantly above the average. It has been shown that those who work more hours tend to report lower overall job satisfaction than those who work less.

However, accounting for the statistics is secondary to acknowledging them and the problem they represent. If so many doctors are failing to meet a basic standard of wellness, something is very wrong, whether it’s risk awareness, prevention strategies, treatment methods, or something more subtle.

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What does burnout say about the doctors who experience it?

The bottom line is that it seems almost farcical to get all our health advice from a group of professionals who themselves suffer from extremely elevated rates of serious health conditions.

It might be tempting to say that this is a sort of false equivalence — that suffering from burnout doesn’t make a physician less likely to prescribe reliable treatment for an ear infection or some other physical condition, because those things are so different.

But are they? Science repeatedly makes it crystal clear that our psyche and emotions play a significant role in physical health. Examples of this include the slower rates of wound healing, heightened susceptibility to cancer, and even decreased vaccination efficacy in people who are stressed.

The medical model, which suggests that all disease is the result of a measurable, physical problem, has been shown to be categorically wrong. And while an increasing number of doctors are taking psychological, social, and environmental factors into account when diagnosing patients, their own collective struggle with wellness casts doubt on the idea that they are truly qualified to tell us what “healthy living” actually consists of.

In contrast to the medical model, the newest way of looking at wellbeing involves all of the above. It’s called integrative medicine, and its success relies on recognizing the fact that every part of a person’s life, from their diet and sleep schedule to their personal fears and aspirations, has a powerful effect on their outward manifestation of health. At its best, this form of medicine also accounts for even the oft-elusive “spiritual” component of health, in an attempt to construct as holistic a view of patient wellbeing as possible.

However, due to a fundamental — and perhaps purposeful — misunderstanding of its methods and intentions, integrative medicine faces an uphill battle when it comes to acceptance in the medical community.

Rather than being evaluated in terms of the dramatically positive outcomes it creates for patients, integrative medicine has been preemptively found guilty by association, since it employs methods that frequently include “alternative” or “complementary” treatments.

Never mind the fact that alternative and complementary therapies like acupuncture, biofeedback, and therapeutic massage often lead to better results for those suffering from a number of illnesses than the more prevalent, medical model of healthcare. The more important point to understand is that integrative medicine is not synonymous with either of these, but rather a comprehensive approach that combines the conventional with the alternative.

The failure of the medical community at large to properly understand these facts about integrative medicine not only does harm to patients who could benefit from its application, it does harm to the practitioners themselves. Doctors who experience burnout, for instance, could no doubt benefit from taking a more holistic view of their own wellbeing, starting with a hard look at how their career is affecting their health.

For those physicians who do acknowledge their own health risks, an integrative approach to managing symptoms and preventing disease would likely lead to drastically better outcomes than simply treating symptoms as they arise. This “band-aid” style of medicine leaves underlying problems unaddressed, and could put physicians on a slippery slope to over-medicating themselves in an attempt to compensate. Self-poisoning is, in fact, the primary method by which medical professionals take their own lives (which, as we’ve seen, occurs at a significantly above-average rate).

This view isn’t intended to be alarmist. A failure to personally understand or adhere to the views embodied by integrative practitioners doesn’t necessarily put a doctor at risk of burnout, physical illness, or suicidal behavior. However, seeing health and wellness as the product of a sphere of internal and external influences (rather than an effect of straightforward biological causes) is no longer a fringe, new-age philosophy — it is now the accepted scientific view. If healthcare providers can’t adjust to it, as exemplified by their personal wellbeing, then how can we trust them to help us make decisions about our own health?

Whether we’re interested in preserving the health of the medical professionals who attempt to care for us, safeguarding our own health as individuals, or optimizing healthcare delivery to better society as a whole, the solution is the same: we need our doctors to take a step back from the medical model and see that it’s far from the whole picture — it’s just one piece of the puzzle.

By Dr. David Minkoff
Contributor

Physician, Serial Entrepreneur, and Lecturer, LifeWorks Wellness Center

Dr. David Minkoff is a Physician, Author, and Lecturer. He is Co-founder of LifeWorks Wellness Center & Founder of BodyHealth. view profile

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