Our health system fails both doctors and patients
As divisive and angry debate continues to rage between Ontario’s doctors and government over cuts to the health-care budget, it is worth asking whether our current health-care system is, in fact, “healthy.” A successful and sustainable system must care for the needs of health-care practitioners and patients equally. As a physician, I have spent years on the front lines of Canadian health-care, and have struggled as much as anyone to compensate for the inadequacies of our system, ultimately becoming ill myself as a consequence.
In medical school, I learned the causes of illness, and exhaustive lists of the medications indicated to treat them. No problem seemed out of reach for modern, pharmaceutical-centric medicine: it was just a question of finding the right medication for the right symptom. “Health,” on the other hand, was rather taken for granted, assumed to be simply the absence of disease. The idea that physicians could themselves become ill was not discussed, and certainly never crossed my mind. Given the relentless demands of my job at the hospital, I found myself rushing headlong from work, to play, and back to work again.
“Modern illnesses” such as diabetes, cardiovascular disease and cancer have come to dominate the contemporary health-care picture, and although it is increasingly obvious that they are rooted in the same lifestyle and environmental causes, modern medicine still tends to treat them as separate and distinct. For example, for a patient with the right genes, the combination of sedentary lifestyle and our overly processed diet is a recipe for diabetes. Modern medicine’s response is to prescribe drugs such as glyburide and insulin, both known to lead to obesity and heart disease: should the diabetic then develop heart trouble, additional medications will be called for, and the prescriptions begin to snowball.
In my experience, it’s rare for patients on multiple medications to feel “better.” In fact, the more pills they take, the worse they often seem to feel. As I gradually came to terms with this contradiction, my early enthusiasm and idealism started to erode. I realized I was more a health manager than healer, prescribing escalating numbers and doses of medications for diseases that would never be cured. My involvement seemed to be expected only once poor health was firmly and irreversibly established, and then only to prescribe medications aimed at dealing with the symptoms rather than the underlying problem.
Gradually, I became not just disenchanted, but angry at the endless need, angry that the expectations of my patients so regularly exceeded my ability to help them. It was a feeling that ran counter to everything I believed about myself and about medicine. It didn’t occur to me that other physicians might have similar feelings; I just thought it was a personal failing. I worked harder to compensate, often to exhaustion. And my life went more and more to extremes: I isolated myself from family and friends, drank too much, rarely slept, and ate poorly.
I felt awful. I felt trapped. Finally, in April 2009 I had a “burnout,” and left the hospital. It was months before I could work again. I was physically and emotionally drained. More than this, I felt ashamed. To me, a doctor was someone who soldiered on in spite of everything, and to falter meant to fail both my patients and profession.
It took me a long time to recover. With help, I pieced my life back together bit by bit. I saw a therapist. I started meditating. I realized that far from representing a “failure,” my experience had been an invaluable lesson in what really constitutes health and well-being. I also realized that I was not alone: according to one study, 45 per cent of Canadian doctors have symptoms of advanced burnout.
Not every doctor reacts to the stress of hospital life as negatively as I did. However, it’s worth asking whether we can continue to expect physicians and other health-care workers to fill the gaps in our health-care system — gaps that are only widening as the government tries to rein in spending while the demands of the population continue to grow.
For my part, I feel healthy today — healthier than I ever did before my burnout. What seemed like “the end” turned out to be a beginning. Out of my efforts to rebuild my own health has emerged a new practice, one focused on lifestyle change and natural remedies, and one that respects my needs as much as those of my patients. And where my life once felt empty and unhealthy, it is now full and satisfying.
Such a transformation is also needed for modern health care. The media’s current focus on OHIP fees for doctors overlooks the fact that “success” in the doctor-patient relationship can’t be measured in dollars and cents. The health-care system must promote not just the well-being of the patient, but also of the practitioner: it’s hard to point the way to health if you are not healthy yourself.
Marc Engfield, MD, is an integrative medical doctor in Ottawa. Email: DrEngfield@yahoo.ca.
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