Sudden & Premature Death among Doctors: How to Save the Saviours?

Introduction

Doctors are life (and sight) saviours and work extremely hard to make the right diagnosis and perform life (or sight) saving procedures. They often have hectic work hours which leave them little time for self-care and rejuvenation. As per Commentary the Indian Medical Association’s (IMA) Pune chapter, an Indian doctor’s average lifespan is 55-59 years, which is almost 10 years less than that of the general population who can on average live up to 69-72 years. Early deaths in doctors can be due to cardiac arrest, hypertension, diabetes, and other such diseases. While doctors are equipped with facts, knowledge, and awareness about various health conditions, they are able to do little for themselves owing to long hours and work stress say members of the medical fraternity [1, 2, 3]. During the past few years, the sudden death of young medical professionals in India shocked the entire medical fraternity. The death of a renowned cardiologist from Gujrat at the age of 41, should be a wake-up call for doctors to carve out some time for self-care and rejuvenation. A few months back, the sudden demise of a Kolkata-based famous ophthalmologist due to massive myocardial infarction came as shocking sad news for ophthalmic colleagues. Similarly, a few young, highly skilled, and talented eye surgeons from NABHA, Punjab, Jhunjhunu, Rajasthan, and a few others, succumbed before the age of 45-50 years. Sudden early deaths have frequently been reported among medical professionals during the past few years [1, 2, 3]. This indicates an alarming trend of the sudden death of doctors and is also closely associated with stress/burnout, a sedentary lifestyle, long working hours, and socio-economic factors.

Sudden Deaths among Medical Professionals?

One of the most important reasons is overwork, stress, lack of physical activity, and lack of regular health checkups. Young and middle-aged doctors are in a critical period of their family and professional career development. Not only do they hope to make breakthroughs in clinical services as well as academic research, but they also face pressure from patients and their families. The escalation of contradictions between doctors and patients has also become an increasing mental burden in the practice of many medical professionals.

Stress, The Silent Killer

Middle-aged doctors have heavy familial responsibilities, such as paying bank loans for medical/ophthalmic practice, supporting parents, rearing children, and making mortgage payments, which cause them to work harder (six to seven days a week) without any breaks. Deteriorated working environment, serious violence against doctors, and decreased patient–physician trust also intensified the sense of “stress/ burnout” in doctors. Male medical professionals, especially in a surgical specialty and operative care, have larger overloads and longer working hours, which may be the primary cause of death. Besides, incorrect stress relief manners also affect doctors’ heaths, such as excessive alcohol consumption, smoking, and long-term energy drink consumption. Lack of exercise and obesity also increase the risk of acute myocardial infarction and stroke. Medical professionals usually neglect regular medical checkups themselves, which results in some potential diseases not being timely detected, such as diabetes, coronary artery disease, hypertension, hyperlipidemia, and hyperuricemia, etc.

Cancer among Medical Professionals

Cancer has figured prominently in the Indian Medical Association study as a causative agent for premature death among medical professionals [4]. However, a direct relationship between doctors’ premature death and cancer needs to be examined more precisely through well-conducted studies. Theoretically, medical professionals are exposed to various occupational and environmental factors that may increase cancer risk. Doctors are a unique group of individuals who are routinely exposed to multiple carcinogens, such as ionizing radiation and various chemicals. Exposure to high doses of diagnostic and therapeutic ionizing radiation is known to increase the incidence of various cancers, like those of the thyroid and the ovary. The high incidence of differentiated thyroid cancers among doctors specialized in various disciplines of radiology is testimony to this. Even young residents in the specialty are reported to be associated with a higher incidence of cancers. Besides radiation and chemicals, the other factor known to cause cancer among doctors is stress itself. Stress caused by a heavy workload, burnout syndrome, compassion fatigue, and chronic sleep deprivation can cause cancer.

Suicide among Medical Professionals

In addition to cardiac ailments, and cancer, suicide among Indian doctors is a concern and remain one of the important cause of sudden death among medical students/ residents and young medical professionals. The medical profession is considered more stressful, but mental health is still a subject of taboo in the medical profession in the Indian context. Medical professionals have a higher suicide risk, 2.5 times more than the general population [4, 5].

Karoshi & Karojisatsu Death

Deaths by overwork in Japan are so common that there’s a unique word for it — Karoshi. According to published news, a 26-year-old doctor in Japan took his own life after working more than 200 hours of overtime in a month. His family said he developed depression after not taking a day off in three months. Suicide due to overwork is known as Karojisatsu, a rapidly rising trend among residents and young medical professionals.

How to Save the Saviours?

Every effort should be made to promote a healthy work- life balance, especially for residents-in-training and female doctors/medical professionals. The important issues need to be addressed and the nobility of the profession must be restored where health care is not merely a commercial commodity and doctors aren’t money-making machines.

Their compassion and empathy need to be preserved and their grievances are taken into consideration. Medical professionals overlooking their health, and ignoring the early warning symptoms is the other primary reason behind premature death. Having greater knowledge and a better understanding of mental and physical health issues, doctors must not undermine their own well-being for the sake of their profession or other things. They will do no good to their patients if they aren’t taking adequate care of themselves first. This is why the phrase heal thyself is used by doctors frequently [4].

The onus is on medical professionals/ophthalmologists to take responsibility for their own health. They must not be reluctant to seek advice from specialists among their colleagues, and not attempt to treat themselves. Those known to be genetically prone to vascular disease must pay attention to addressing modifiable risk factors and effective lifestyle changes that could contribute to a catastrophe. Those known to have cancers running in families must subject themselves to stringent cancer screening programs. Medical professionals/ophthalmologists must function humanely, doing justice to the nobility of their profession, and not sidestepping their responsibilities and accountability toward patients. They must keep open the channel of unconditional communication founded on honesty, truth, and readiness to accept responsibility, for patients and their families.

We suggest that each and every ophthalmologist/doctor should take responsibility for his/her own health. Medical professionals/ophthalmologists should regularly perform aerobic exercise or connect with families and friends for support, instead of excessive smoking and drinking. Besides, regular medical checkup (blood pressure, blood sugar, ECG, Echocardiography, etc) is an effective approach to detecting and decreasing the risk of some potential diseases such as diabetes, coronary artery disease, hypertension, and stroke. Government, non-government organizations, medical/ ophthalmic societies, and media should help to improve the working environment and re-establish doctor-patient trust, which may further decrease the sense of “stress/ burnout” for doctors. A change of lifestyle and healthy work- life balance-adding yoga, exercise, and meditation to reduce stress, maintain quality eating, and maintain body weight can save many young doctor/ophthalmologist lives.

Conclusion

Lifestyle changes for all medical professionals include: practicing what you preach, eating healthy, not smoking, and not drinking excessively. Every doctor should take time out for himself/herself and walk in a garden, listen to music, and meditate. Get the blood tests and health check-ups done yearly. Treat cholesterol, hypertension, and diabetes. The doctor should not neglect any symptoms. Sleep at least 8 hours a day as there is no substitute for sleep. Money is essential for life, but graves have no banks so take vacations and regular breaks and spend time with family. Health is the greatest wealth and the health of the entire nation depends on medical professionals. But, to achieve that goal, first, the medical professionals need to be healthy. As they say while boarding an airplane safety briefing: we must first ensure to put on our own oxygen masks, before we help others.