Written in 2004 as an Op-Ed writing homework assignment for a Public Health class~ and still a propos today!
Recent debates about resident work hour reform have called attention to the critical connection between the health of physicians and the care of patients. We have learned that frazzled, sleep-deprived physicians are likely to make mistakes—some crucial to the lives of patients, like Libby Zion, an 18-year-old girl whose 1984 death at Cornell Medical Center’s emergency room catapulted the issue of overworked and under-supervised house officers into New York courts. Though no physicians were found to be at fault, New York state woke up and tried to prevent future problems by passing a law to limit the number of hours residents can work. Years later, the rest of the country finally opened its eyes, and in July 2003, the Accreditation Council for Graduate Medical Education instituted laws requiring all accredited U.S. teaching hospitals to limit work hours to less than 80 hours per week.
Although well-intentioned, however, these resident work hour regulations are really nothing more than a band-aid (not to mention a logistical nightmare to implement) for the problems of an overworked profession. Medical errors made by sleepy doctors are not the only pitfalls—there are also more subtle manifestations of a hyper-stressed physician lifestyle that may interfere with patient care. For example, can an out-of-shape cardiologist—who has no time to take proper care of her or himself—truly and effectively communicate with patients about the utmost importance of exercise and healthy eating habits? Will a patient suffering from angina really listen to a frenzied ER physician, fresh off a power bar and double espresso lunch break, impart the importance of reducing stress levels in life? Since when did ‘Do as I say, not as I do’ become a part of the Hippocratic oath?
While reducing resident work hours may temporarily lighten some heavy eyelids on the wards, the situation necessitates a more far-reaching reform that would encourage a healthier physician lifestyle and accountability for a doctor’s own habits. This reform should start early, targeting the first days of physician-making, and be sustained throughout the environment of the medical community as a whole.
Many students enter medical school directly from college—carrying with them an over-achieving drive for success that pushed them through AP exams, SATs, MCATs, numerous all-nighters and endless extra-curricular activities. The stresses of medical school only perpetuate these unhealthy habits until they become a permanent way of life for many student doctors. Undoubtedly, the rigors of medical school are necessary evils that encourage mastery of the material—but students should also be encouraged to apply their newly-acquired knowledge about anatomy, health, and nutrition to themselves. For example, medical schools should require, or at least strongly recommend, a physical fitness elective or a nutritional seminar. The point here is to make students aware from the beginning of their own habits—and to teach them how to keep the unhealthy ones in check. We are training the future physicians with whom our nation’s health will be entrusted—so why can’t we also teach these students how to be accountable for their own lifestyles? Our country certainly does not tolerate hypocritical behavior in politics, finance, and the media—so why is it ignored from day one in the making of an American doctor?
This encouragement of physician health should continue into the workplace. Medical centers and hospitals are no longer places solely for the treatment of disease and sickness—they are now bastions of preventive medicine. Yet, look around at the vending machines, the coffee pots, and the couches. Instead of an environment that encourages stagnancy and sugar/caffeine consumption, medical centers should practice what they preach. Replace the candy in the vending machines with healthy snacks, for example, or reduce the amount of soda machines and include more water and juice options. Why not make a health and fitness center—either onsite or nearby—available for both physician and visitor use? Blowing off steam on a treadmill, or giving oneself a good stretch, is arguably more beneficial then overdosing on caffeine.
These types of broad-sweeping changes would, of course, necessitate research to demonstrate their efficacies. But if we start small, one improvement in the health, lifestyle, and workplace of a physician may have untold ripple effects in the patient population—in a Pay It Forward sense. The bottom line is this: Physicians have an incredible potential to positively influence the lives of patients—but until we can learn to lead by example, this power will remain largely untapped.