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Clinical Warnings That You’re Working Too Hard

Discussion in 'Hospital' started by The Good Doctor, Apr 28, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    Residency teaches you to push past your perceived limits. However, even physicians are mortal. While you may be able to sustain a frenetic pace for a short period of time, long term overwork has profound health consequences. Those consequences include increased risk of heart attack and stroke, memory impairment, and diabetes.

    Can you spot the signs of overwork in yourself and your colleagues? Here’s what research suggests you should be looking for.

    You’re drinking more

    It seems many are drinking more under the added stresses of COVID-19. Researchers recently queried more than 1,500 American adults about their drinking habits during the pandemic and presented their findings in a recent JAMA research letter. Seventy-five percent of respondents said they’re drinking on one additional day monthly, and it appears “heavy drinking” has increased by 41 percent among women.

    Alcohol intake among doctors is also up during the pandemic, according to a recent MDLinx report. But prior to the pandemic, those who received performance-based incentives, such as those based on patient volume, may have been predisposed to drinking. A 2020 Journal of Population Economics study shows that those who receive performance pay are more likely to use alcohol and drugs. The researchers theorized that substance use, as a coping mechanism, may increase with the added associated stress of performance-based pay.

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    Researchers have also pinpointed a work-hour threshold for increased alcohol consumption. It turns out, according to a BMJ meta-analysis, those who work more than 48 hours weekly are more likely to increase alcohol intake to levels that put their health at risk. When was the last time you worked fewer than 48 hours, doctor?

    You’re sleeping less

    Sleep struggles are also an indicator that you may be working too hard. Furthermore, it appears work is keeping many Americans up at night. A 2018 Accountemps survey of 2,8000 US workers found that 44 percent lose sleep over work somewhat often or very often. Fifty percent said the chief cause was feeling overwhelmed by work volume and hours. Forty-eight percent said they can’t stop thinking about a business problem, and 20 percent said they lost sleep over strained coworker relationships.

    Sleep disturbance has health consequences, particularly in aggregate. You can count hypertension, dyslipidemia, cardiovascular disease, weight issues, and metabolic syndrome among those health consequences, according to a Nature and Science of Sleep meta-analysis.

    If you’re having trouble sleeping, it could be a sign that it’s time to take a vacation. Barring that, a consistent sleep routine may improve your sleep quality and duration. Begin by experimenting with this one.

    You’re feeling depressed

    Perhaps one of the more obvious signs of overwork are symptoms of depression. According to DSM-5, some depression criteria include depressed mood most of the day, nearly every day; diminished interest in activities most of the day, nearly every day; and diminished energy, among five others.

    Research has shown that overwork among physicians is associated with symptoms of depression. A Journal of Health and Social Sciences study analyzed a group of 135 Japanese physicians working overtime at a national university hospital. The physicians received questionnaires that evaluated depressive symptoms, among three other symptoms. The data showed that depressive symptoms seem to increase with overtime and decrease as work hours decline.

    “These findings indicate that limiting overtime could be useful to maintain good mental health and prevent overwork-related health problems among hospital physicians, by emphasizing the important roles of occupational physicians and health surveillance at (the) workplace, which should be successfully implemented,” the researchers concluded.

    Your heart rate variability (HRV) is low

    HRV is measured in the millisecond variation between heartbeats. When we’re at ease, the level of variation tends to be higher. When we’re stressed (physically or emotionally), it tends to be lower. A 2020 study published in Medicine indicates that HRV may be a useful burnout indicator.

    Researchers studied a group of 120 Taiwanese tech workers. Each received a biographic questionnaire, burnout inventory questionnaire, and finally, an HRV reading, which provides insights pertaining to autonomic nervous system function, and consequently, the stress response.

    “HRV is an objective method to evaluate occupational burnout and can be used to screen out employees at a higher risk for cardiovascular problems,” the researchers concluded. “With early intervention and/or health education and promotion to these employees, the prevalence of burnout and even cardiovascular diseases can be prevented.”

    Your cortisol levels are high

    Cortisol is useful if you need to run from a tiger, but detrimental if it’s flooding your body all the time. For example, the body has a difficult time differentiating between the tiger and finding time to cook dinner, according to the Mayo Clinic. The resulting hormonal flood of the stress response, which includes cortisol, increases blood glucose, and suppresses digestion and the immune response.

    There are blood, urine, and saliva tests that measure cortisol levels. If you’re needle-squeamish, you might want to stick to the latter two to avoid a skewed result. Abnormal cortisol levels could also indicate Cushing syndrome, the result of too much cortisol, or Addison disease, too little.

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