The Case of Mr LR

My first junior doctor role as an HO (house officer) was at a district general hospital in Kent. I was part of a team led by a consultant vascular surgeon, let’s call him Mr LR. My first job of the day was to bring chewing gum to the doctor’s mess at 7 am, where the team would debrief.

Over an instant coffee, Mr LR would inhale three back-to-back cigarettes, I’d hand him a minty stick of gum, and we’d set off on the daily ward round. I’d watch him getting increasingly agitated as the round wore on, having to retire to the mess mid-morning to get his fix.

In the six months I worked in his firm, it never ceased to amaze me how much this man smoked. Despite his occupation (much of which involved lobbing off dead limbs almost always due to the ill effects of smoking), he was a champion chain smoker himself. His team comprised an angry bully of a surgical registrar, an SHO (senior house officer) who, obese and breathless, would struggle terribly around the wards, and me. I won’t get started on how unhealthy I was.

Yes, ladies and gentlemen - I present your medical team!

Do As I Say, Don’t Do As I Do

Doctors and nurses - presumably health experts - are notorious for not looking after themselves, even as they spend all their time trying to look after others.

When I think about my long-suffering colleagues and my own shocking attitude to health as a junior doctor, I ponder why we were so very poor at self-care. Several factors come to mind, although I’m sure there are more:

1. Ignorance of basic health facts - education, family and cultural influences
2. Lack of self-awareness
3. Delusion - It-Wont-Happen-To-Me Syndrome
4. Denial - I can’t bare to face it
5. Confidence - I can’t do it; it’s too hard
6. Environment - overworked, undervalued, stressed. And everyone else is unhealthy too!

If I was to make a guess, Mr LR suffered a little from 3 and lots of 6; my SHO perhaps had larger doses of 1, 2 and 5. Me? Inflicted by all of the above at one time or another.

Can you relate to any of this in your life? What’s your number one reason that holds you back from being healthier? Is it environmental, psychological, cultural, or educational?

Physician Heal Thyself

Godfather of lifestyle medicine, Dean Ornish, implores us to ‘move more, sleep better, eat well, stress less and love more’. Those simple instructions sound so easy yet appear so difficult to implement, including for those of us spouting the message.

As much as I preach healthy living to all and sundry, I’ve struggled with it and still do. I used to berate patients saying they must do better, whilst, behind the scenes, I was a health mess. I thought nothing of telling a patient they must improve their diet when half an hour later, I’d be frantically scoffing packets of crisps in front of the computer screen at lunchtime.

I’m by no means a finished article (the crisp scoffing still occurs, I’m afraid). But at this point, I don’t feel as comfortable anymore lecturing someone to "do as I say, don't do as I do."

Am I being hard on myself? To what extent do we health professionals have a duty to role-model healthy behaviours for our patients? Must the physician heal thyself first? I think, yes. Or at least we must try. Because persuasion and advocacy are surely more effective and authentic if we embody what it is to be healthy - to know that mastering lifestyle, psychology and behaviour matters.

Conditions for Healing

So, this particular physician continues to try to heal herself the best she can. From my own experience, I have some suggestions.

Let’s come back to the list.

1. Ignorance. Learn, educate yourself, and ask.
2. Self-Awareness. Where it all begins. Learn what holds you back. Might I suggest yoga?
3. Delusion. Be honest, take responsibility, open your eyes and see reality. We will all get sick and die; I’m sorry to tell you. However, you may have some control over how quickly and in what fashion.
4. Denial. “Not everything that is faced can be changed, but nothing can be changed until it is faced.” - James Baldwin. Enough said.
5. Confidence. Build it and believe in yourself. Use a coach, friend, therapist, doctor, anybody or anything (movement practices are brilliant for this) to help you.
6. Environment. Make your environment work for you, not against you. So change what you can, however small.

Speaking of Environment…75 years of NHS

Strikes continue to hit the NHS right now. People ask me, do I agree with it? I hear it from all sides, and the pain is real for everybody. We seem to spend all our time apologising. I would ask, what do we expect of the NHS now? Its staff are undervalued, underresourced and overworked. NHS workforce absence is higher than ever, with a quarter of sickness due to mental health. Awful.

What kind of environment is this? How can NHS workers hope to be functional, let alone healthy, when they are so stretched? I didn’t think so twenty years ago when I was observing from the bottom of that surgical hierarchy, and definitely not now.

Care Plan

Should we blame Mr LR for smoking or being a workaholic - shouldn't he know better? Or do we fault his environment - a challenging workplace like the NHS - so he need not take any responsibility for his individual behaviour?

I imagine Mr LR now (he may well be dead, or also de-limbed if he continued the way he did) and wonder what might have helped him become a healthier man - a decent holiday once in a while, therapy to understand why he was always so angry, and extraction from a systemic culture where everybody is expected to just cope with it until they break.

What to add to his care plan? A medicinal drip of peace, love and understanding, to be sure.

If we find ourselves struggling like Mr LR, it's important to cultivate self-awareness, honesty, compassion, and confidence - fertile ground to feed our healing journey. By creating these inner conditions that support our well-being, we may be able to heal and even inspire positive change in our surroundings.

The physician can absolutely heal thyself.

Can you?

Let's practise.