Domains of Wellbeing: Health
Today we continue our discussion about the four domains of wellbeing. So far, we’ve explored both personal life and work life as separate domains. We’ve also begun thinking about how these domains interact with and affect each other. It’s easy to imagine how a personal crisis can affect an individual’s performance at work or how a work crisis can be more difficult to handle if one’s personal life is out of balance.
Crisis vs. Transition
I want to point out as well, that crisis is quite a loaded word. It’s easier (and more dramatic) to imagine a crisis than what occurs more frequently: a transition. Often things are merely out of balance (aka changing from one status quo to another) in a person’s life. This change can cause as much upset as a crisis (like the death of a loved one or losing a job).
Some examples of transitions in personal life and work life could be:
Marriage
Buying a house
Expecting a child
Receiving a promotion
Getting an advanced degree or certification
While these are generally perceived to be “happy” or “joyful” transitions, they can still cause stress and temporarily have a negative impact on the wellbeing of an individual as they adjust to their new status quo.
Today’s Domain: Health
While keeping the consideration of personal and work life in mind, today, we’ll explore the third domain: Health. We’ll use the World Health Organization’s definition of health, which is not just the absence of illness but presence of wellbeing (1).
Health is not the absence of illness but the presence of wellbeing.
Let’s travel back in time…
The traditional Greek god of medicine Asclepius, whose staff with a snake is part of the logo of many medical societies, had five daughters, each one representing a significant aspect of health (2). They are Hygieia ("Hygiene", the goddess of cleanliness), Iaso (the goddess of recuperation from illness), Aceso (the goddess of the healing process), Aegle (the goddess of good health), and Panacea (the goddess of universal remedy).
Studies show that, at this point in modern history, Panacea (aka the treatment) gets more attention than the other equally important daughters in the current healthcare system. Physicians are paid to treat rather than prevent. This is also true when physicians turn to care for themselves.
Since we are focused on the transition of individual physicians and other clinicians from illbeing to wellbeing, a rhetorical question begs to be asked: “When it comes to your personal life, will you prevent illbeing and promote wellbeing for yourself or not?
What factors contribute to illbeing for physicians?
Physicians are in a stressful vocation, there is no doubt. Maintaining health -- wellbeing -- as opposed to simply staving off illness, is of the utmost importance if a physician wishes to thrive in both the personal and professional arena.
Research shows that illbeing factors of most concern for physicians are alcohol abuse/dependence, depression, suicidal ideation, and suicide itself (3).
While exact numbers are not known, statistics are often approximated as 300-400 physicians/year, or roughly a doctor a day lost to suicide. Perhaps even more alarming is that, after accidents, suicide is the most common cause of death among medical students (4). U.S. physicians live longer than other professionals and the general population on average, making the high prevalence of suicide among physicians an important and preventable target of intervention (5). Of all occupations, the medical profession consistently hovers near the top of those with the highest risk of death by suicide.
These terrifying statistics indicate that, without a doubt, absence of disease does not equal health. We must, now more than ever, include mental health as a crucial part of the conversation about an individuals’ health and wellbeing.
In every population, suicide is almost invariably the result of untreated or inadequately treated depression or other mental illness that may or may not include substance or alcohol abuse, coupled with knowledge of and access to lethal means (6).
Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females. Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms. A survey of American surgeons revealed that although 1 in 16 had experienced suicidal ideation in the past 12 months, yet only 26% of those sought psychiatric or psychological help. There was a strong correlation between depressive symptoms, as well as indicators of burnout, with the incidence of suicidal ideation. More than 60% of those with suicidal ideation indicated they were reluctant to seek help due to concern that it could affect their medical license. This concern about regulatory interventions is a very common hindrance to seeking needed help for mental health issues.
While it is a bit of a leap to state that burnout leads to depression and suicidal ideation, it is much easier to read these statistics and insist that doctors be given the same right as every other individual to seek mental health support without endangering their livelihood.
Still, the majority of physicians do not seek regular medical care at all. Other research suggests that 1 in 3 physicians has no regular source of physical or mental medical care (7). Mental health experts who have studied physician depression and suicide stress that immediate treatment and confidential hospitalization of suicidal physicians can be lifesaving—more so than in other populations. Yet, the specters raised by this approach—the fear of temporary withdrawal from practice, of lack of confidentiality and privacy in treatment, or of loss of respect in the community—are often major impediments that keep physicians from reaching out in a time of crisis and seeking effective treatment. A clear cut case of the old aphorism: the cobbler’s children have no shoes.
Unfortunately, physicians’ hesitation to seek help is well-founded. Those who have reported depressive symptoms (even those for which they are receiving effective treatment) to their licensing boards, potential employers, hospitals, and other credentialing agencies, have experienced a range of negative consequences, including loss of their medical privacy and autonomy, repetitive and intrusive examinations, licensure restrictions, discriminatory employment decisions, practice restrictions, hospital privilege limitations, and increased supervision.
Such discrimination can immediately and severely limit physicians’ livelihoods as well as the financial stability of their families. For this reason, well-meaning colleagues or family members who are aware of the depression sometimes discourage physicians from seeking help. Self-treatment further complicates things, often leading to substance or alcohol abuse, or worse.
Mental and physical health must be discussed in tandem and not as separate issues -- mental health IS physical health just as mental wellbeing IS physical wellbeing. And when it comes to wellbeing, we are looking at the entire individual across many aspects of their life.
Without sufficient healthcare support, and confidence that they can access treatment without discrimination or loss of livelihood, physicians are unlikely to ever reach their full potential.
Next week, we’ll continue our discussion of domains by exploring wealth and finances. Looking at domains both individually and in relationship to each other will help us to understand how wellbeing functions in everyday reality.
If you are looking for more practical ways to thrive and reach your optimal level of wellbeing, get in touch to get started. Let’s create a customized program that’s perfect for you!
Sources:
Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of WHO, no. 2, p. 100) and entered into force on 7 April 1948.
Asclepius. Wikipedia. https://en.wikipedia.org/wiki/Asclepius. Published May 31, 2020. Accessed June 8, 2020.
Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician Suicide: A Call to Action. Mo Med. 2019;116(3):211‐216.
Yaghmour NA, Brigham TP, Richter T, et al. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med. 2017;92(7):976‐983.
Frank E, Biola H, Burnett CA. Mortality rates and causes among U.S. physicians. Am J Prev Med. 2000;19(3):155‐159.
Physician Suicide. Overview, Depression in Physicians, Problems With Treating Physician Depression. https://emedicine.medscape.com/article/806779-overview. Published November 12, 2019. Accessed June 8, 2020.
Gross CP, Mead LA, Ford DE, Klag MJ. Physician, heal Thyself? Regular source of care and use of preventive health services among physicians. https://pubmed.ncbi.nlm.nih.gov/11088080/