Commentary by Randy D. Danielsen, PhD, PA-C, DFAAPA
After 40 years as a PA (including 21 in academia), tucking myself safely into my seventh decade of life, I was feeling fairly invincible. Yes, I was experiencing increased fatigue and intermittent dizziness, but I attributed those to normal aging and my hectic schedule. Purely to get my colleagues and loved ones off my back, I agreed to see my primary care physician—but, feeling that I had little time for this and knowing that my health was just fine, thank you, I scheduled my appointment for a month later.
That appointment resulted in a referral to a cardiologist (which I didn’t think I needed) and a carotid ultrasound (which yielded negative results). I was still begrudging the time spent on these appointments, when my treadmill test revealed some ST changes in the lateral leads. OK, yes, I do have a positive family history for heart disease! But still, I was surprised.
This finding led to a nuclear treadmill test, which showed some ischemia. The cardiologist suggested an angiogram to rule out a probable false-positive result. Now, I really didn’t have time for this, either—but having gone this far, I felt it was important just to get it over with. Thank goodness I did!
During my angiogram (by the way, they give you great LaLa Land drugs), the interventional cardiologist discovered a 95% blockage of the circumflex, a 95% blockage of the right coronary artery, and a 60% blockage of the LAD. The big decision at that point, amidst the obvious shock of my mortality, was whether to opt for an open-heart bypass or stents. I chose stents (which, by the way, have had a significant impact on my energy level). My cardiologist tells me that, without the stents, if I had experienced a total occlusion event, I would not have survived. Quite a sobering thought!
My purpose in sharing this story is not to call attention to myself but rather to offer a wake-up call to those of us who think we are invincible. Many colleagues who have heard my story have decided to get their own long-delayed treadmill or other health-related tests. So here is my call to action to all of you: Take care of your health. The irony is that, for health care providers, this can be difficult.
Those who care for others often have a tough time caring for themselves. We know that physicians are notoriously bad patients, and I think PAs/NPs are no different. We deal with life-and-death issues all the time, and outward displays of distress are, at a minimum, discouraged. In general, our training and accumulated experience help us to develop good coping skills: We are taught to ignore basic human needs (like hunger and fatigue) and to remain capable, competent, and compassionate clinicians under highly stressful conditions.
Nonetheless, we experience these high levels of stress and seldom act to relieve them. As long ago as 1886, Dr William Ogle exposed clinicians’ vulnerability to high mortality risks, but to this day, the subject remains fairly neglected.1 Perhaps as a result of stigma—we worry about confidentiality, or that our colleagues will consider us inadequate or incompetent clinicians, or that a display of “weakness” means we have failed in some way—we often wait too long to seek treatment. Often, it takes a crisis before we stop to care for ourselves.
We promote the health of our patients, but we often forget that if health is to be sustained, those who provide the help must be capable of caring for both themselves and others.2 Without being overly prescriptive, I would like to share with you some suggestions for how you can take care of yourself:
- Maintain a positive attitude. Yes, we often set ourselves up for failure, but we must have patience with ourselves. There are countless ways to practice reflection and find some time to think; it could entail an artistic outlet such as painting, sculpting, sewing, or singing. A colleague of mine listens to affirmations (now available by smartphone app) that she says help her succeed in her daily endeavors.
- Identify your support systems. You know who they are: family, friends, and colleagues who bring positive support to your life. Spend more time with them. Clinicians with strong family or social connections are generally healthier than those who lack a support network. Make plans with supportive family members and friends, or seek out activities where you can meet new people.
- Choose healthy, well-balanced meals. This is probably one of the most difficult tasks, due to our hectic and busy lifestyles. We should strive for low-fat, low-sugar, low-salt, high-fiber, and reasonably low-calorie meals. And drink more water—at least 6 to 8 glasses per day.
- Get an appropriate amount of sleep. Restorative rest is one of the things you can control and should—no, must—give priority to. It is known that sleep is key to competent delivery of care. The National Sleep Foundation suggests seven to nine hours per night for those ages 26 to 64 and seven to eight hours per night for those older than 65.3 (In fact, some studies have suggested an increase in stroke linked to sleeping longer in older age.4)
- Schedule time for a sustainable exercise program. Put it on your calendar, and make that the one meeting that is essential. (This is another area in which technology can help, by providing reminders that you need to get up and move.) You don’t have to go to the gym twice a day or run a marathon. Walking for an hour three or four times a week will make a difference; even a 5-minute walk after a stressful meeting can help. Just do it!
- Schedule time for R&R. Over the past decade, a staggering number of studies have demonstrated that our work performance plummets when we work prolonged periods without a break. Use your vacation time! A recent Harvard Business Review article reported that employees who take vacation are actually more productive.5 Make time for yourself—no one else will!
- Take care of your mental health. Stress is a fact of life. Do what you can to relieve it; develop good coping skills and use them. You may find that keeping a journal in which you can vent your frustrations and fears or taking your dog for a long walk helps to relieve tension. Find what works for you. And make sure to laugh and find the humor in life. Laughter has been shown to boost the immune system and ease pain. It’s a great way to relax!
- Take care of your physical health. Caring for your body is one of the best things you can do for yourself. Reduce or eliminate risk factors. Please get your routine health promotion procedures done (eg, colonoscopy, Pap smear, mammogram). And when you experience signs of illness, don’t ignore them! Seek advice early for anything out of the ordinary, be it intermittent dizziness, recurrent fatigue, unintended weight loss, feelings of despair—I could go on.
If even a handful of you heed these suggestions, and doing so makes a difference in your health and longevity, then I have completed my mission for this editorial.
We should be role models for our patients. The societal focus on healthy lifestyles is a challenge for all of us, but the benefits are enormous. I would love to hear from you regarding ways to enhance our physical and mental health and avoid early morbidity or mortality. You can reach me at [email protected].
- Woods R. Physician, heal thyself: the health and mortality of Victorian doctors. Soc Hist Med. 1966;9(1):1-30.
- Borchardt GL. Role models for health promotion: the challenge for nurses. Nurs Forum. 2000;35(3):29-32
- Hershkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43.
- Leng Y, Cappuccio FP, Wainwright NWJ, et al. Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta-analysis. Neurology. 2015;84(11):1072-1079.
- Friedman R. Dear boss: your team wants you to go on vacation. Harvard Bus Rev. June 15, 2015.