Commentary

To Thine Own Health Be True

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After 40 years as a PA (including 21 in academia), tucking myself safely into my seventh decade of life, I was feeling fairly invincible. Yes, I was experiencing increased fatigue and intermittent dizziness, but I attributed those to normal aging and my hectic schedule. Purely to get my colleagues and loved ones off my back, I agreed to see my primary care physician—but, feeling that I had little time for this and knowing that my health was just fine, thank you, I scheduled my appointment for a month later.

That appointment resulted in a referral to a cardiologist (which I didn’t think I needed) and a carotid ultrasound (which yielded negative results). I was still begrudging the time spent on these appointments, when my treadmill test revealed some ST changes in the lateral leads. OK, yes, I do have a positive family history for heart disease! But still, I was surprised.

This finding led to a nuclear treadmill test, which showed some ischemia. The cardiologist suggested an angiogram to rule out a probable false-positive result. Now, I really didn’t have time for this, either—but having gone this far, I felt it was important just to get it over with. Thank goodness I did!

During my angiogram (by the way, they give you great LaLa Land drugs), the interventional cardiologist discovered a 95% blockage of the circumflex, a 95% blockage of the right coronary artery, and a 60% blockage of the LAD. The big decision at that point, amidst the obvious shock of my mortality, was whether to opt for an open-heart bypass or stents. I chose stents (which, by the way, have had a significant impact on my energy level). My cardiologist tells me that, without the stents, if I had experienced a total occlusion event, I would not have survived. Quite a sobering thought!

My purpose in sharing this story is not to call attention to myself but rather to offer a wake-up call to those of us who think we are invincible. Many colleagues who have heard my story have decided to get their own long-delayed treadmill or other health-related tests. So here is my call to action to all of you: Take care of your health. The irony is that, for health care providers, this can be difficult.

Those who care for others often have a tough time caring for themselves. We know that physicians are notoriously bad patients, and I think PAs/NPs are no different. We deal with life-and-death issues all the time, and outward displays of distress are, at a minimum, discouraged. In general, our training and accumulated experience help us to develop good coping skills: We are taught to ignore basic human needs (like hunger and fatigue) and to remain capable, competent, and compassionate clinicians under highly stressful conditions.

Nonetheless, we experience these high levels of stress and seldom act to relieve them. As long ago as 1886, Dr William Ogle exposed clinicians’ vulnerability to high mortality risks, but to this day, the subject remains fairly neglected.1 Perhaps as a result of stigma—we worry about confidentiality, or that our colleagues will consider us inadequate or incompetent clinicians, or that a display of “weakness” means we have failed in some way—we often wait too long to seek treatment. Often, it takes a crisis before we stop to care for ourselves.

Continue for suggestions on how to take care of yourself >>

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