For some months I have been experiencing recurrent mouth ulcers and angular cheilitis. The latter is a little embarrassing, as sometimes the irritation can look like I have spilled food on my face, leading to colleagues and patients occasionally commenting or discreetly signing at me to wipe my face. Oddly enough, it was the embarrassment of it all, not the physical discomfort of my symptoms, that prompted me to finally act. Like many health professionals I had put my symptoms down to stress and being overly busy, which seemed reasonable given I had just taken on new leadership roles. My blood tests showed I was iron deficient again. This is no surprise as I am a vegetarian who is not good at eating iron-rich foods (a kilo of spinach each day gets a little tedious long term) and 2 years ago I needed an iron infusion. Having the answer for my symptoms is helpful, but I now need to find the time to see my general practitioner (GP) and then have another iron infusion, which I will no doubt defer until the symptoms get worse given my hectic schedule. Importantly, like countless other health professionals, I am not alone when it comes to ignoring my own health. So why do health professionals neglect their own health? Our professional lives are devoted to safeguarding the health of others, we have intimate knowledge of health and disease and yet we fail to apply this to ourselves. The answer is of course multifactorial, including systemic pressures, cultural norms within medicine, and internalised expectations that we should put others before ourselves. Yet this is not reasonable, fair or safe. Furthermore, we have known this for thousands of years given the biblical quote 'physician heal thyself', which highlights the importance of self-care, personal wellbeing and addressing our own issues, before trying to help others. A key issue is the culture of self-neglect in medicine, which values resilience, stoicism, and self-sacrifice. This culture is not just implicit, but explicit, as health systems contribute to personal self-neglect by requiring clinicians to work excessive hours with numerous competing demands. Workload pressures, understaffing, under-resourcing, and administrative burdens create unsafe work environments and contribute to fatigue, mental illness, and burnout. Therefore, we learn early in our careers that we must put the needs of patients before our own, even when this comes at personal cost. This ethos contributes to harmful behaviours such as ignoring illness, avoiding medical appointments, or self-medicating. Furthermore, it is well documented that many doctors continue working when unwell (presenteeism), which can lead to errors, burnout, and worsened outcomes for both physicians and patients 1, 2. Yet, health professionals are not superhuman! We are mere mortals who get sick. In fact, the prevalence of mental health disorders, particularly depression, anxiety, and burnout, is alarmingly high among physicians 2. Suicide rates among female physicians are also significantly higher than in the general population 3. Furthermore, mental health symptoms, moral distress, and suicidal ideation among health professionals were well recognised during the COVID-19 pandemic 4-6. Psychological illness not only profoundly affects the individual and their family but also impacts patient care. Burnout has been linked to increased medical errors, reduced empathy, and higher turnover rates 2. Health professionals often also ignore physical health issues. Long hours, sleep deprivation, irregular meals, and limited exercise are common during clinical training and often persist throughout an individual's career. Many physicians have variable access to healthcare; hence they manage their own medical care 7. Notably, when we neglect our own health, it sends a message to colleagues, trainees, and the public that self-care is not a priority or even a legitimate need. Thus, this contributes to an ongoing cycle of self-neglect. There are multiple barriers preventing health professionals from accessing healthcare. Stigma and fear of professional consequences such as mandatory reporting, fitness-to-practise investigations, or reputational damage are important issues. Additionally, time constraints and lack of access to confidential services are also critical barriers. Many doctors report difficulty finding time to see a GP, particularly during working hours. Even when services are available, concerns about confidentiality can discourage help-seeking 7. Tackling these issues requires action at multiple levels. Culturally, we need a paradigm shift towards valuing self-care and prioritising personal health. We must stop focussing on personal resilience and blaming individuals for being unwell (physically or psychologically). Occupational burnout is a workplace problem, not the fault of the individual. Organisations have legal and ethical responsibilities to provide safe workplaces, which includes safeguarding psychological health. Indeed Australia, like some European countries, has now introduced legislation that grant employees the 'right to disconnect', setting clear boundaries regarding after hours work and communication 8. This is a step in the right direction, but more action is required. Health care organisations must invest in confidential, accessible support services for clinicians and provide protected time for health appointments. Additionally, organisational mentoring and peer support programs are important supports. However, critically, governments need to address the endemic problems within our health systems, with substantial long term investment required in the health workforce and other resources, in addition to workload reforms. Recognising and addressing the systemic, cultural, and personal barriers that prevent clinicians from caring for their own health is essential for a healthier workforce and safer patient care. So it is time for this physician to 'heal herself' and book in for that iron infusion. The author declares no conflicts of interest.
Natasha Smallwood (Mon,) studied this question.