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Editorial JULY
2008
Taking Care of Ourselves: Being a Role Model for Patients
Patricia J. Sulak, MD
Although my practice has shifted primarily to office gynecology, I’m wondering
if I am really a psychiatrist, internist, and nutritionist. Women come to see
me for Pap tests or are referred for gynecologic problems, but these are rarely
the paramount health issues in their lives. For example, here are some of the
patients
I saw today:
- A 350-pound, 30-year-old referred to me for heavy, irregular menses,
arrived in her motorized wheelchair.
- A 42-year-old who smokes a pack of cigarettes a day complained of decreased
libido; on questioning, she revealed angry outbursts and marital discord with
her second husband but declined referral for counseling.
- A 26-year-old presented with painful vulvar lesions; she has had 7 sexual partners
but relates she is “pretty good” about using condoms; she became
distraught when told she has herpes.
- A 43-year-old who came for her annual exam with numerous complaints including:
decreased libido, lethargy, inability to lose weight, decreased interest in life,
mood swings/irritability. Review of her chart shows progressive weight gain of
5 to 10 pounds per year over the last 8 years. On questioning, she has no hobbies
or interests except running the kids everywhere, and is on no diet plan or exercise
program. She claimed she “doesn’t have time.”
Despite the numerous life-saving advances we have made in medicine—from
improved diagnostic testing,
to miracle medications, to surgical wonders—my clinic is filled with women
who have numerous self-induced medical conditions, are not happy, and are often
depressed. Many are complicating their lives and harming their well-being with
unhealthy behaviors: sedentary lifestyle, dietary indiscretion, multiple sexual
partners, and tobacco abuse, to mention only a few. These health risk behaviors
lead to the #l killer of women (cardiovascular disease) and the #l cancer killer
(lung cancer).
In addition, women are often
so overextended with their jobs, caring for family members (children, elderly
parents), fullfilling household responsibilities, and participating in community
activities that they complain they “do not have any time for themselves.” I
often hear: “I can’t exercise because I don’t
have time.”
“I hardly eat anything and I just can’t lose weight.” “I can’t quit
smoking.” By the end of the day, the conversations have been filled
with inCANTations.
They are looking for the quick fix: the magical pill or the surgical procedure
that will cure all of their problems and make them happy. Antidepressants are
one of the most commonly prescribed classes of medications. Gastric bypass
and banding are no longer rare operations. All of this is complicated by the
fact that most gynecologists don’t have the training to deal with these
complex issues. We’re not trained in psychology and often do not have
the expertise to advise people on healthy diets and exercise programs. Also,
with the pressure to see more and do more, who has the time to have an in-depth
discussion about these issues?
All this leads to the question: Are we, as health care professionals, good examples
for our patients? Do we follow a healthy diet? Are we within our ideal body
weight? Do we exercise regularly? Do we not overextend ourselves so we can
have quality time for ourselves and our loved ones? Or, are we running ourselves
ragged worrying about RVU production, Press Ganey scores, climbing the academic
ladder, or getting the next research protocol/manuscript out the door? Are
we taking care of our own physical, emotional, and spiritual health?
I am fortunate to work with a group of physicians who are quite healthy and happy.
They are all within their ideal body weight and almost all exercise regularly.
Several have also immediately sought medical care when a symptom arose, escaping
significant morbidity, and even death. They take time off to pursue interests
and to be with family and friends. They are always willing to pitch in and
help when a colleague needs to take time off, for whatever reason. And importantly,
most are incredibly benevolent regarding involvement in diverse projects with
overseas mission work, the local maternity shelter, the sexual assault program,
and the adolescent sexual health program in our area schools, plus many others.
In truth, I often overextend myself. But, I’m getting better. I have put
myself on the list of things that must be taken care of each day and I try not
to “cancel” my time. I refuse to give up my almost daily exercise
hour, my book-of-the- month club, and my women’s group. I recently went
away for the weekend with my husband with no medical meeting to attend! As health
care professionals, it begins with us. Even in this hectic, hustle-bustle world,
we have to work ourselves into our schedules. Not only will this be great for
us; we will be awesome examples for our patients, our family, and all those with
whom we come in contact.
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Patricia J. Sulak, MD, Associate Editor
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