The Necessity of Self-Care

What group of people make the worst patients? Some may say it is those who march in with ridiculous demands educated by countless WebMD searches and fueled with guidance from Facebook groups. Others may say it is attorneys or maybe even nurses. The obvious answer in my opinion is that, as a group, doctors far too often make the absolute worst patients. This is not because we are overly noncompliant or argumentative, although that may be true in some cases. No, the primary reason is simply because doctors often avoid being a patient altogether. Far too often we neglect small warning signs, unintentionally delaying care until issues become too big to ignore. We clearly understand the importance of periodic exams and well visits and believe in the adage that an ounce of prevention is worth a pound of cure. Rather, doctors often struggle to follow the very advice recommended to patients because we allow our work and home lives to get in the way, choosing to prioritize other needs above ours. Ask yourself: Can you remember the last time you saw your primary care provider, if you even have one? What about regularly visiting a dentist or optometrist?

This issue is not new to health care nor is it confined to one part of the globe, as evidenced by a multitude of studies and surveys in existing literature. An older study from Australia in 2004 found that roughly half of doctors surveyed lacked an established relationship with a primary care provider.¹ An online survey² of roughly 300 family and internal medicine physicians conducted in 2019 by The Harris Poll on behalf of the Samueli Integrative Health Programs found that 80% of respondents felt their own self-care was “very important.” However, only 57% practiced it “often,” while 36% reported practicing self-care “sometimes.” The most common reason for inadequate self-care: lack of time (72%).

We commonly delay seeking nonurgent or emergent care for ourselves for no other reason than we deem it inconvenient due to interfering with the multitude of other responsibilities. Other convenient excuses include patient-care duties, lost revenue, and ramifications for our employees if practices are closed. Who can afford to take time off for a doctor’s visit when that requires closing the office for the morning or afternoon? Preventative or routine care is easily overlooked or neglected because there simply is not enough time, certainly not with busy clinics and practices to run, procedures and cases to complete, and patients to see. Add in the lengthy list of items waiting for completion outside of work, and self-care easily slides right to the bottom of the to-do list despite the best of intentions.

However, by postponing or avoiding preventative self-care, doctors do a serious disservice to not only themselves but also to the people who depend on them: families, employees, business partners, and patients. As doctors, we must be as honest about our own health and well-being as we are about the health and well-being of our patients. We must recognize that if we fail to keep ourselves healthy, we are at serious risk of failing to provide for those who need and depend on us.

Throughout the past decade and particularly after the COVID pandemic, there has been exponential growth in recognizing the importance of mental health and self-care, especially for health care providers. Although self-care has been defined in several ways, it essentially entails preserving or improving all aspects (ie, physical, mental, emotional, and spiritual) of one’s health in collaboration with health care professionals as needed. Stress is undoubtably ubiquitous with a career in health care from the onset of our education. Dental school or residency is often so hectic that very little time, if any, is carved out for simple stress reducers such as working out. As our professional careers continue to take off, the stressors of life continue to accelerate and accumulate. Far too often our diets also begin to suffer, with skipped lunches or hurried meals during the precious few minutes in between patients. Many doctors even struggle to take actual time off as work stresses mount. I have found that several of my academic colleagues fail to utilize their full complement of vacation days year after year. To what end? How many have gone on a much-needed vacation only to question its usefulness upon returning and seeing the avalanche of work that accumulated while away? All of these factors combined with the common avoidance behavior many doctors exhibit lead to poor health and wellness, which threaten to undermine us as health care professionals and humans.

The COVID pandemic shed light on the ill-advised decision for health care workers to return to work before resolution of one’s symptoms and illness. Prior to the pandemic, it was commonplace for health care providers to struggle through a workday only with the aid of cold and flu medication, all the while potentially exposing colleagues, staff, and patients to a virus. The unspoken expectation for doctors was to not miss work unless necessary. Thankfully, there seems to be greater appreciation for the counterproductive nature of such a mentality. People are now actively encouraged to stay home until healthy, which only required a pandemic to occur to usher in this welcome change in protocol.

Where to go from here? Unfortunately, there are no easy answers. The inherent expectations and responsibilities of being a doctor often requires one to prioritize the patient. Time-sensitive patient concerns and emergencies demand our attention despite often encroaching upon our personal lives. Stressors such as running payroll, managing staff, and ensuring the lights stay on are simply nonnegotiable. As doctors, we accept these challenges as a tradeoff for the benefits that working in the health care profession provide such as job security, associated salaries, societal status, and a rewarding career. Working remotely is not an option for most readers of Anesthesia Progress who are clinicians. Simply put, patient care is our business, so we must be present and ready to work every day.

Rather, we must focus on ensuring time is carved out to take care of ourselves while balancing work and home life demands. Like the preflight instructions given by flight attendants, we must put the oxygen masks on ourselves first to ensure we are then able to help others. Doctors need to follow stress reduction strategies rather than perpetually burning the candle at both ends. Doctors should prioritize self-care to maintain proper health and ensure protected time for routine health care visits rather than always waiting for an illness to occur first. We must recognize that all health care providers have physical, mental, and emotional limitations and strive to carefully balance the litany of demands from work and home without sacrificing our own health. We owe it not only to those who depend on us but also to ourselves.