Dr. Ruhlen is courageous to openly discuss his health problems. An international study by the British Medical Association in 2007 found many doctors who are sick do not seek help because of the stigma of ill health or because of peer pressure. “This stigma attached to ill health reinforces the perception that ill health is akin to inadequate performance and unacceptable conduct,” according to the report. These beliefs lead many physicians to work through illness and self-treat.
Another danger as hospitalists take on more and more patient care and co-management is overwork. A case in point is the harrowing story from one hospitalist who shared his insights on condition of anonymity.
“I suffered from a multiyear bout of workaholism,” he says. “I used to laugh about it when initially diagnosed thinking, ‘How could this be a bad thing?’ As time went by I realized it follows the same stages of nearly every other addiction—and the consequences can be just as devastating. I lost 90% of my friends. At one point I was within days of losing my wife and family. My overall work performance significantly worsened despite increasing time devoted to work. My patient satisfaction scores dropped.”
The load also took a physical toll.
“My personal health deteriorated as I stopped making time for the gym and moved from a healthy diet to a quick-carb/junk-food diet. Work became my drug, and like all drug abusers—I suffered a great deal. During my second year as a hospitalist I developed hyperthyroidism. I’m embarrassed to admit how far it progressed before I made the diagnosis.”
Initially, the symptoms are positive ones, this hospitalist notes.
“I could get by on less sleep, always had bundles of energy, could dictate three times faster than anyone around me, and could eat anything and everything in sight and still lose weight,” he recalls. “My daily hospital rounds that typically take eight to 10 hours were often completed in four to six hours. Then came the sweating … followed by the tremors, which is not very conducive to performing delicate procedures such as inserting central venous catheters. The palpitations and eventual chest pains came next and prompted me to seek care.”
This hospitalist has since found a healthy balance—but it took hard work.
“Once I accepted that I had a work addiction, I began setting boundaries and had my wife remind me (which she needed to do often at first) when I was pushing the bounds,” he explains. “Over time I was able to resume a more balanced life.”
Having overcome his work addiction, he finds the signs easy to spot among his peers.
“Workaholics (unless you work under them) often look like super heroes,” he notes. “They say yes to every assignment. They always put 120% in. They are often the go-to person. On the rare occasion I do identify it in a colleague, I’ll let them know. I’ll tell them what it did to me and my family. Sometimes they listen—usually they’re too busy working to listen.”
A Hard Life
While hospitalists experience the same unhealthy stresses as other physicians, they may face unique demands caused by their chosen specialty.
“Hospitalists are at the forefront of an evolving new specialty,” Dr. Ruhlen says. “In order to create satisfaction with the specialty and help it evolve, you’re willing to extend yourself above and beyond what others in different fields might be doing. So you take the extra shifts when you don’t quite have enough people in your group. You get up early and go to meetings to promote your practice within the hospital. And maybe you stay up later at night than you ordinarily would have because you want to make sure you absolutely provide the best care.”