Physicians have false feelings of invincibility and omnipotence - Dr. Shujat Ali Naqvi

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Over 400 doctors commit suicide in USA every year

Physicians have false feelings of invincibility 
and omnipotence - Dr. Shujat Ali Naqvi

They are all susceptible to all mental and physical illness like their patients

LAHORE: Physicians must take care of their health. Most of them usually have false feelings of invincibility and omnipotence though they are susceptible to all mental and physical illnesses like their patients. Physicians matter because they are somebody’s child, parent, sibling, friend, colleague or physician. Hence, they must admit their vulnerability and seek help. This was stated by Dr.Shujat Ali Naqvi Consultant Child and Adolescent Psychiatrist from United States. He was making a presentation on Physician’s mental health: A biopsychosocial and spiritual model for care at the recently held Asia Pacific Conference on Psychosocial Rehabilitation in Lahore last month.

Dr.Shujat Ali Naqvi

Studies have revealed that almost 35% of physicians do not have a regular source of healthcare. They often delay in seeking treatment for medical or psychiatric illnesses and they remain “wounded healers”. Some of the reasons for this are overt/covert discrimination in medial licensing, hospital privileges, health and malpractice insurance. Medial students have lack of time, confidentiality, stigma, cost and fear of documentation on academic record of the illnesses they suffer from. Doctors most often remain under stress and Oscar once said that “Managing One’s Own stress is the toughest part of practicing Medicine”. Stress, Dr. Shujat Ali Naqvi stated is bad and it all depends on how you take it.
Talking about the Fight or Flight Response Dr. Shujat Ali Naqvi said that mediated by epinephrine and acetylcholine results in increase in heart rate, increase in blood pressure, it also affects oxygen and glucose delivery to tissues. It leads to sweating, pupillary dilatation, excitability, anxiety, panic, irritability, concentration difficulties and distractibility. Its short term consequences include poor decision making, decreased ability to interact effectively and decreased ability to execute skills. The long term consequences lead to Burn Out, poor health, decreased wound healing besides impaired immunity.
Speaking about stress among residents Dr. Shujat Ali Naqvi said that residents face stress because of inadequate sleep, they are frequently working in shifts for more than twenty four hours; they do not have inadequate leisure time. They have feelings that their personal needs were inconsequential. One of the studies revealed that 34% of residents said their life was stressful. Females report stress more frequently than males. Time pressure was one of the contributory factors. Almost 14% said they would change their specialty while 22% said they will not practice medicine and 17% of residents reported their mental health as fair or poor.
Some other factors leading to stress include changes in healthcare system, political and economic uncertainty, workload, practice management, financial problems besides increasing expectations of the patients and the public. Hence, it is important that physicians must balance their professional responsibilities with personal lives. Some of the common personality trait of physicians includes exaggerated sense of responsibility, adaptive for training, potentially detrimental to profession, personal and family lives, and chronic feelings of not doing enough. Another survey have revealed the physicians to be obsessional and perfectionists, ambitious and self sacrificing, high expectations for performance, low tolerance for uncertainty, difficulty with emotional expression, inadequate coping skills and dynamic of replacing their own needs with those of their patients. We must remember that Voltaire had said, “The perfect is the enemy of the Good”. At times the physicians come under lot of pressure, feel helplessness and hopelessness. They are vulnerable to depression, anxiety, and burn out and may also have idea of suicide. Fear of not being in control leads to their low self esteem and their satisfaction with real achievements remain limited.
Dr. Shujat Ali Naqvi was of the view that one must always ask for sexual life while examining a physician colleague. Many physicians’ relationships are unsatisfactory, although they tend to stay married. This relationship is also dependent on which spouse is a physician and the stage of training and practice. Studies have failed to show any correlation between long working hours and poor marriage or divorce. The psychology of postponement leads to psychology of avoidance. Highlighting the source of conflict in the medical marriages he mentioned lack of time for fun, family and self, amount of time at work and frequency of sexual relations, lack of intimacy and money management matters. However, dual physician relationship has some positive aspects as well like greater family income and enjoyment related to shared work interests. Female physicians have increased risk of divorce than male physicians. Divorce is reported to be highest in psychiatrists followed by surgeons. Higher levels of marital and parental satisfaction are associated with minimizing role conflict, a supportive spouse. Almost 60% more female physicians are likely to report burn out as compared to male physicians. Female physicians are also at greater risk of sexual harassment and they have to struggle with domestic responsibilities and balancing roles.
Talking about burnout symptoms, he mentioned insomnia, fatigue, sommatization, headache, illness and hypertension. Spiritual burnout leads to loss of faith and also change in religious beliefs. Depression is more common in women including female physicians. Depression is also reported to be higher in medical students and residents as compared to general population. Physicians are also reported to have highest suicide rates and according to reports almost four hundred doctors commit suicide in United States every year. Self diagnosis and treatment should be avoided. Unrecognized and untreated physician impairment, Dr. Shujat Ali Naqvi opined will lead to medically dangerous patient care, poor supervision of medical students and residents. Families will suffer from neglect. They will have loss of work satisfaction, loss of professional stature and career progression eventually leading to premature death. Most of the physicians committing suicide in United Sates are elderly, are faced with challenges of life and wish to dye with grace. Risk assessment among the physicians, Dr. Shujat Ali Naqvi stated was extremely important. Post myocardial infarction depression is far more lethal for repeat MI and never forget to talk about sexual history while examining a physician colleague, he reiterated.

 


 

Dr. Nasir Izhar along with Prof. Sultan Ahmad and Dr. Naeem chairing
one of the scientific sessions at Asia PAcific Conference on
Psychosocial Rehabilitation held at Lahore recently.

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