A few weeks ago, my longtime friend and personal physician refused to grant any more prescription refills for the two medications that I have taken regularly for close to a decade. In a very professional tone, he firmly (and appropriately) pointed out that it had been more than three years (please don’t judge me) since I had been examined or subjected to any routine screening lab work. Having now been trapped by my physician on the one side and my spouse on the opposite, it was futile to resist. I relented. (extended sigh) Fortunately, the scrutiny of my physiology disclosed no cause for alarm. There was, as expected, the slight increase in my weight (only five pounds or so) and a very slight increase in my blood pressure (likely explainable by the weight gain) but not enough to make a change in my medications. Yet there was one surprise. My vitamin D level was substantially below the lower limit of normal. This, in turn, gave me an opportunity to engage in some self-reflection. It goes without saying that vitamin D is a crucially important nutrient. Every schoolchild knows it’s essential to maintain healthy bones. What’s not commonly known is that vitamin D has many other functions and probably some that haven’t even been discovered yet. In a review article in the New England Journal of Medicine, Michael Holick points out that vitamin D deficiency has even been linked to mental illnesses like schizophrenia and depression. * It caused me to wonder about a possible connection with “burnout.” Another unique feature of this remarkable steroid is that it’s the only vitamin that we don’t have to ingest in order to maintain adequate levels. If fact, there aren’t even a lot of options for ingestion. The most prominent dietary source of vitamin D is the flesh of fatty fish and beef liver. I don’t really have a taste for either. Milk and many commercially produced cereals are fortified with vitamin D, but again, these are not high among my culinary preferences. The good news, of course, is that ingestion of vitamin D is not required to maintain perfectly acceptable levels of this crucially important co-factor. It is, in fact, the only member of the vitamin family that we can manufacture completely on our own, just by taking a walk in the sun. For that last choice, I have no excuses. I live nearly an hour’s drive from the nearest urban environment. I live in the South, where it’s a very rare day that being outdoors is hazardous or even unpleasant. And perhaps most important of all, I’m retired from the active practice of medicine, so the time available to me is abundant. Yet, I spend an enormous amount of my time indoors, peering into a screen, playing with the dogs, reading or possibly gazing out the window at the breathtaking lakeside view that fronts my home. There is no conceivable excuse to relinquish the opportunity to walk out the door and go create some vitamin D. It doesn’t really take that much time — certainly not enough to be concerned about the skin cancer risk. And best of all, vitamin D has a very long shelf life in our bodies. With just a little sun exposure on a regular schedule, one can store quite enough D2 and D3 make it through the winter — even if it’s in Minnesota. But that’s more-than-enough physiology. What I really sat down to write about was the unfortunate capacity of physicians to care for everyone but themselves. And I must admit that through most of my career, I was a “poster child” for that malady. The advice I got when entering private practice as a surgeon was very simple: In order to succeed, you have to subscribe to the principle of “ability,” i.e., availability, affability, and surgical ability. It was no accident that availability occupied first place, and surgical ability came in last. The “customer” was the referring physician and saying “no” to a referral was just not an option. Fortunately for me, I truly loved my job, both the scientific and technical challenges and the gratitude of patients who entrusted themselves to my care. Unfortunately, those rewards are not enough to offset the damaging effects of fatigue and social isolation. The more modern version of physicians and surgeons, interestingly, faces a different set of challenges that are as damaging and possibly more so than what my generation endured. Employment by organizations that don’t share the mission of your professional oath and measure you only by your productivity (carefully tracked by an electronic medical record) will empty your soul in an instant. To them, you are not a healer. You are merely overhead. The terse admonition “physician, heal thyself” is often misunderstood. When Jesus spoke those words to his fellow Nazarenes early in his ministry, he was merely saying what they were all thinking. Namely that “you’ll have to show us a miracle or two before we take you seriously as a Messiah.” In the era when I began my practice, there was little resistance to the word of physicians. We made the rules by which health care would be delivered and that practice was rarely questioned. Realistically, that wasn’t the best way to do things and I have no desire to return to the “old ways.” That said, it is critical that we are heard and respected for the special knowledge and expertise that we alone possess. In order to accomplish that, we will, in fact, have to heal ourselves first. That begins with caring for our own minds and bodies, and souls. It means not avoiding (as I did) caring for our own physical and especially our mental health. It means we must be a part of the lives of our families and loved ones as well. Once that is accomplished, then and only then can we move on effectively to heal and revitalize our beloved profession. And likewise, that is not a battle that can be shouldered alone. We must join with and support each other. We must arm ourselves with knowledge and motivation by taking advantage of mentors and coaches. And perhaps most importantly, we must be aware of when we need to be the mentor and when to be the protégé. Only then will we heal ourselves. Source
