Social Histories If you were to sit in on any routine doctor’s visit, you are bound to hear a few common questions. “Do you smoke? How much alcohol do you drink, if any? What is your diet like? How much exercise do you get weekly?” These are questions we are trained to ask as early as the first week of medical school. We are taught to treat not just the conditions a patient presents with, but also inquire about their overall health and instruct them on ways to improve it. Addressing negative social habits that can impact patient’s health is a recurring theme throughout medical school. My classmates and I have learned how to recognize drug addiction and drug-seeking behavior, how to determine if our patients were alcoholics, and effective ways to counsel people on healthier diets. As much as we future doctors know what qualifies as “good” health, and how to attain it, I wonder how closely we follow our own advice. Medical students work incredibly hard, studying for hours on end for very difficult exams, as well as spending long days in the hospital without pay. With this amount of dedication, certain things are almost automatically erased from our lives. Sleep deprivation is the first thing that comes to mind, and I am constantly aware that this will only get worse when I start residency. Though the field of medicine has made great strides in ensuring that residents have work hour limitations, and the days of sleeping in the hospital all weekend are largely behind us, the amount of work still leaves many constantly fatigued. We counsel our patients to have good sleep hygiene, and often attribute lack of sleep to problems with mood, concentration, and general quality of life. But what about us? We set ourselves up for failure in these areas when six hours of sleep is a good night’s rest. Doctor Non-Compliance This lack of good sleep directly leads to an increase in the amount of stress we put on our bodies and minds as students and physicians. Let’s face it: medical school is stressful. This is a point that needs no clarification. Passing exams, getting honors on clerkships, and resting all of our hopes on a few board exams is pressure nobody enjoys. The stresses that come along with a career in medicine are certainly matched in other fields, but most other professionals do not spend their days advising their clients to avoid stress. How ironic is that? I have seen the effects stress can have on people, including my classmates: dissolution of relationships, family strife, and depression, to name a few. While we tell our patients to go easy on themselves when they are having trouble in their personal life or at work, we do not afford ourselves the same luxury. The last, and possibly most important, area that I notice physicians and other healthcare professionals not taking their own advice is in our indulgences. Long hours, high student debt, and a relatively low salary can restrict medical students and residents from having the healthiest habits in terms of diet and exercise. When you have to round quickly on patients and get to the OR by 7 am, it is not uncommon that all you have the chance to eat is a light snack or coffee. Throughout the day the demands of the patient wards may prevent you from having a real meal, and the vending machine seems like it may as well be a Michelin star restaurant. In spite of this, I am constantly impressed by a small subset of my peers who manage to make exercise a focal point of their day, whether it be at 5 in the morning or 10 at night. Many of us—and our patients—do not have this will power or motivation, and will collapse into our beds the second we have a minute to do so. Other indulgences include drugs and alcohol, the unspoken hidden addictions many doctors struggle to control. The House of God provides anecdotal evidence: “the classic novel where residents take swigs out of a flask at work and aim to be inebriated as often as possible when off the clock. This is a work of fiction, but it is based in reality.” Physicians are often incredibly vulnerable to addiction when it comes to alcohol and drugs. It may be because we self-medicate, thinking we can recognize a problem more easily since that is what we were trained to do. Hence, we quickly and easily enter the world of self-denial. It is not uncommon to hear stories of physicians overdosing on prescription drugs or attending AA meetings. This is nothing to be ashamed of, and it is always good to get help when it is needed. However, the pressure placed on us not to have such problems—and to hide them if we do—makes it harder to identify and treat addictions when they do exist. Some Of Our Own Medicine We should strive to be the best versions of ourselves always, but also recognize that we are not above the maladies that may afflict our patients. If a patient states they are struggling with work and feel they need to drink more lately, it is okay to recognize that you as a doctor have experienced that problem too. When you advise your patient to cut back on the booze, take a day off work, and get better, remember that can be an option for you as well. The next time you ask your patient if they are downplaying a problem, ask yourself the same question. It is just as important to care for yourself as it is to care for others. Remember, just because there’s no lecture on it in med school, doesn’t make the problem any less real. Source
