Addressing The Problem Of Physician Burnout

/ Thomas Cohn, MD

One of the front page articles this week in the StarTribune explored the subject of doctor burnout. Every job comes with stress; Medicine is not immune to stress and burnout is becoming a more recognized phenomenon. Many jobs have the pressure to perform, but many doctors try harder to push through the stress and daily duties. Recently, we began to realize we are no different than everyone else.

Medicine has for a long time been a very strenuous career. The academic requirements and training are very difficult. Most of us started our careers with residency training involving workweeks that exceeded 80 hours, and we continued working 50-60 hours each week after residency was complete. The time spent seeing patients is only a fraction of the time spent – many more hours involve paperwork, patient preparation, administrative tasks, and continuing education. Family and fun time become eclipsed by work requirements, and sleep is an afterthought.

Tired Doctor

Daily Doctor Stresses

Stress becomes a lifestyle. Seeing patients and being able to identify the correct diagnosis and treatment is always a challenge. Many physicians also perform complex procedures that could easily cause significant damage if something goes wrong, adding to the stress. Then, if patient is at all unhappy, we may have to deal with administrators questioning the encounter or the possibility of being sued.

Preventing stress and burnout in any profession is necessary. One may be busy, but to prevent burnout, one needs to take time out from work. Physicians need to do this just like everyone else. Some physicians take extended breaks from practice, taking months off at a time. They do charity work and get away from their normal practice. Others limit their work hours. Many try to find outside interests to focus on to reduce stress. No one goes to their graves saying that they wished they spent more time at work.

Work is only a small part of life. Maintaining outside interests is essential. Stress comes as part of the profession. Ways to handle the stress include maintaining good fitness and having outside interests that you enjoy. Often, the outside interests of a physician can be seen readily at their offices. A physician with no outside life besides medicine may be more likely to become burned out. Stress reduction for everyone is necessary. It is summer time and now is a time to be outside and enjoy the world.

 

The Importance of Regular Summer Exercise

/ Thomas Cohn, MD

The unofficial start of summer has come and gone as the Memorial Day weekend is in the rearview mirror, and that means we are in full swing of the outdoor season. Spring cleaning and all the summer chores also have come. It is now the time to become a weekend warrior, and using a bit of wisdom is necessary to prevent injuries. None of us are immune to injury, but using some common sense may go a long way to prevent injury.

One way to prevent injuries during the summer is to stay fit. Fitness involves two aspects – cardiovascular aerobic strength and muscle power strength. Both parts of conditioning are equally important, but many people want to do just one of the two. Without both aspects, injury is more likely.

Summer Workout

Aerobic and Muscle Training

Aerobic conditioning is exercise that stresses the endurance strength of the body. It allows us to continue activities for a prolonged time. The classic aerobic exercise is running. It increases the heart rate and promotes the efficient use of energy. Any activity that increases the heart rate qualifies for aerobic conditioning. This can be fast walking, swimming, bicycling, tennis, or any sport that requires continuous movement. The goal is for most people is at least 30 minutes of day, and this should be outside of “work” so that the brain gets the benefit of relaxation. To further promote this, obtain a fitness tracker, such as a Fitbit and log 10,000 steps a day. Hitting an aerobic goal of 30 minutes of exercise and 10,000 steps will help maintain overall fitness and help with other things such as weight control.

As a pain specialist, strength conditioning has two parts. The first is overall muscle strength throughout the body. The second part is core strength, the muscles that stabilize the spine. Working out at a gym or lifting weights generally works on the large muscles in the body, the arms and legs. Good general strength allows us to do many activities and not hurt later. Core strength is much harder and targets more specific muscles. To strengthen these muscles, one needs to concentrate on working these specific muscles with very targeted exercises. The workout for the core does not require much equipment, often just gravity and body positioning is sufficient to work these muscles. Good resources for core strengthening are available on the web, use the Google search term, “lumbar core strengthening”. A good starter site is available via Princeton. Additionally, many smartphones have good apps for general muscle strengthening exercises.

A good exercise program will help prevent injury. It will give a person more ability to do the jobs around the house and not be to sore afterward. It is okay to be sore for a day or two, but if one is sore longer than that, then one is likely doing too much repetitive work on a single occasion. It is time to become more active, work on both strength and endurance, and spend some time having fun.

Exercises Can Alleviate Fibromyalgia Pain

/ Thomas Cohn, MD

exercise fibromyalgia.Research out of Spain confirmed the belief that exercise and physical fitness can help relieve symptoms due to chronic pain and fibromyalgia.

To conduct their experiment, researchers asked participants to refrain from using pain medications for at least 24 hours, then they measured their pain levels using a number of different scales, including the Visual Analog Scale (VAS), the Pain Catastrophizing Scale (PCS) and the Chronic Pain Self-Efficacy Scale. After pain was measured, researchers surveyed patients about their exercise habits. Although the findings don’t prove causation, researchers uncovered:

  • Patients with higher physical activity exhibited lower levels of pain.
  • Those who exercised more had a lower psychological overreaction to pain.
  • Fitness appeared to decrease negative thoughts about chronic pain.

“These results might have implications for future intervention studies in this population,” the investigators wrote in Arthritis Care and Research. “In general, there was a linear (dose-response) relationship so that higher levels of fitness were associated with lower levels of pain and catastrophizing and higher self-efficacy.”

The team concluded that fitness helped improve overall agility, flexibility and mobility. They believe strength conditioning can help increase pain tolerance, while aerobic exercises can help a person with some of the mental aspects of chronic pain and fibromyalgia.

“Our exploratory analyses suggest that muscle strength and flexibility could be the fitness components most strongly associated with pain levels, while aerobic fitness and flexibility could be the fitness components most strongly associated with the psychological experience (i.e. catastrophizing and self-efficacy) of pain,” wrote the authors.

Dr. Cohn Comments

The benefits of exercise for chronic pain have been well documented, so it should come as no surprise that regular exercise can help alleviate problems associated with fibromyalgia.

I’ve even written about how exercise has helped me control my pain condition. If you’re suffering from chronic pain, try to squeeze in some regular exercise. Even 15 minutes of walking can do wonders for your mind and body. If some exercises are too trying, try to find an activity that works for your condition. Whether it’s running, walking or swimming find an activity that works for you!

Working Through Chronic Pain

/ Thomas Cohn, MD

Living with chronic pain isn’t easy. Some people are awarded full or partial disability, but for many people, those benefits eventually run out or their claim is denied altogether. Because of this, many people are forced to work, even with debilitating chronic pain. Today, we share some tips for getting through the work day with chronic pain.

1. Move Around

You might think you’re making your pain problem worse by moving around, but staying sedentary for long periods can actually trigger chronic pain. For example, if you’re dealing with chronic back pain, staying seated in one position can actually put more strain on your back. Moving around helps build muscle and helps regulate blood flow to affected areas. Try to get up and walk around for five minutes every hour. This doesn’t necessarily mean you need to take a break every 60 minutes – just find an excuse to walk around. Deliver those memos to accounting by hand or walk around while you’re talking on the phone.

2. Don’t Overdo It

While you want to move around, you don’t want to overdo it at work. It may sound obvious, but a lot of workers want to prove to themselves and their coworkers that their pain condition won’t hold them back at work. Lifting heavy boxes or equipment can exacerbate a previous pain condition. Talk to your boss about your condition so there are no surprises when you return to work. If you can’t preform all the typical duties, talk with your boss or your coworkers about other ways you can contribute. For example, instead of loading boxes onto the truck every Friday, maybe you can compile the weekly productivity reports. Being open and honest about your limitations means there will be no confusion about your job duties.

Pain at work

3. Tell Your Boss

As we mentioned above, it’s important to talk to your work superiors about any limitations you might have because of your chronic pain. Lying or trying to hide your pain can be extremely problematic. First, it can affect your disability benefits. If you tell your insurance company that your injury is preventing you from completing all your tasks, but you attempt to push through the pain and complete them anyway, your insurance can deny your claim. On the other hand, if you don’t open up about your condition to your boss, he or she might not be as open to hearing why you didn’t finish a certain task.

4. Adjust Your Schedule

This one again goes hand in hand with the above point. If possible, try to adjust your schedule to accommodate your pain. For example, if you are supposed to take water therapy classes to alleviate your back pain, and the classes are only offered at 8am on weekdays, but you normally work 8am-5pm, ask your boss if you can work from 9am-6pm on Tuesdays and Thursdays so you can get to your treatment. If you can’t adjust your work schedule, do your best to adjust your personal schedule so you can best manage your pain condition.

Insomniacs More Prone to Chronic Pain

/ Thomas Cohn, MD

Findings out of the Norwegian Institute of Public Health suggest that people who have trouble sleeping are more likely to have an increased sensitivity to pain.

Although the study didn’t show a cause-and-effect relationship, researchers said insomniacs were more likely to be sensitive to pain. For the study, researchers asked more than 10,000 adults to dip their hands in cold water for 1 minute and 46 seconds. If they felt the cold water was causing too much pain, participants could remove their hands from the water prior to the completion of the timer.

Insomnia

After their reading was recorded, researchers asked participants a bunch of questions about their sleeping habits, including how long they typically sleep, how long it takes them to fall asleep, and if they suffer from insomnia. Researchers also asked questions about related issues that can make it hard to fall asleep, like anxiety, stress and depression.

Study Results

After looking at the findings, researchers uncovered:

  • Nearly 1/3 of participants were able to keep their hands in the water for the entire test.
  • 42 percent of people with insomnia pulled their hands out of the water early.
  • 31 percent of people without the sleep disorder pulled their hands out of the water early.
  • Participants with frequent insomnia were more likely to remove their hands from the water than people who have insomnia once a month.
  • People with insomnia and chronic pain were twice as likely to have a reduced pain tolerance than participants without those conditions.

“While there is clearly a strong relationship between pain and sleep, such that insomnia increases both the likelihood and severity of clinical pain,” researchers wrote, “it is not clear exactly why this is the case.”

Dr. Cohn Comments

Although the findings are interesting, they are hardly revolutionary. In fact, it’s more of a chicken-and-the-egg type argument. People who have chronic pain are more likely to be plagued by nagging pain, which can make it difficult to fall asleep and stay asleep, and if you don’t get a full night’s sleep, your body can fully recover from the activities of the day, contributing to more pain. So what came first, the chronic pain or the insomnia?

Related source: Health.com