Comfort, Hormesis & Toxicity

Comfort

Comfort is being a zombie.  This is most people unfortunately.  Woken up by an alarm, hitting snooze too many times, waking up late, downing some coffee, getting stuck in traffic, doing a job they hate, coming home eat garbage and watch junk on TV, then going to sleep and on and on it goes.

Toxicity

Some people are born into a horrible situation.  Poor nutrition from birth, not looked after by their parents or society.  Lack of encouragement for education, not striving to be better.  Lack of belief in ones self.

Hormesis

Not enough people know this word.  Not enough people practice this word.  The people who do practice this approach to life are the group of people who embrace life and make it as good as it possibly can be.

Hormesis refers to the fact that a certain level of stress is good for you and makes you a better, stronger human being.

Think of the comfort zone.  The people in this zone do not like to exercise or eat right.  As a result their muscles and also their mind atrophy.

Compare this to the person who hits the gym (not too hard, as this would be cross the line into toxicity).  It’s uncomfortable, it’s painful sometimes – especially leg day….Oh God I hate leg day…. but it makes you stonger, faster, better, hypertrophy.

What would happen if more people applied this philosophy to every aspect of their life.  What would their love life, professional life, creative life, intellectual life be like?

Mind-set

A lot of people say that mind-set is crucial to accomplishing what you want to in life.  Want to create a great business?  Want to get that six pack?  Want to get that girl?  Mind-set is the key.  I agree with this.

Most people believe that mind-set is responsible for around 60 – 80% of what you accomplish.  This is what I disagree with.

Mind-set is a pre-requisite to accomplishing what you want to in life.  I challenge anyone to accomplishing anything in life without being in the right frame of mind.  Have you ever planned to go to the gym the night before but when the next day arrives you feel that urge to work out, fade out?  Then it’s a good time to  get your mind-set in check.

Strike!

If you’re in the UK then you will no doubt have heard of the Junior Doctors Contract palaver all over the news.  I won’t go into too much of the details but just want to put my two cents out there on the interwebz.

Basically Jeremy Hunt – the health minister in the uk – has imposed a new contract on Junior Doctors so that more of them will work on weekends and out of hours.  The contract is “cost neutral” to the government, so basically Juniors will have to work longer hours for less pay to provide this service.

JH

Jeremy Hunt

As a junior doctor (currently in my last hospital post), it is astonishing to think that the government are actually going to try to stretch the juniors even further.

I remember when I graduated and started work as a FY1 doctor in 2012.  I remember vividly how I’d have to be on the ward twenty to thirty minutes earlier than contracted to get ready for the ward round which started at 8am.  I would work continuously doing all the jobs, paperwork, seeing sick unwell patients and most days not finishing before 6.30pm.  I am a pretty fit guy and I would be exhausted after a days work.  It was emotional, physical and mental labour.  It was not an easy job.

Another thing I remember about when I first started working (and actually still hate about the job) was that weekends were incredibly tough.

During a normal working day there is usually a full team of doctors on the ward so that seeing unwell patients and ensuring all the necessary tasks that go into looking after patients gets divided up by the team.  This helps tremendously, but you will still never finish on time and are likely to have to skip your lunch break a lot of the time.

Weekends are a different ball game.  Usually on the weekend there is a team of doctors, but you will be covering a whole bunch of wards and also having to deal with new admissions and having to sort out all the patients who deteriorate throughout the day.  These shifts are the ones that all new doctors fear and they never stop being unpleasant even after years of experience.

I always thought that this type of work and abuse of doctors was a travesty for such a rich nation.  I always thought that once the public knew what doctors do (and heck most of the patients felt sorry for me when I worked in acute surgery, because they knew I was working my butt off!) then people would finally cry out for the NHS to get proper staffing levels.  It is unfair to treat junior doctors the way they are already being treated!  I don’t know of anyone else who works in such a pressurised system.  These weekend on call shifts often mean that you will be the sole doctor responsible for 100-300 patients!  What are you meant to do when more than one patient is sick and needs immediate attention?!  This will be a topic for another post…

But essentially what I’m saying is that with Hunts contract there will be less doctors on normal week days and maybe more on the weekend.  The doctors working weekdays are already stretched.  The doctors currently working weekends are at breaking point.  With this contract the doctors working both weekdays and weekends will be completely burnt out and demoralised continuously.  This will also cause patient harm as there simply won’t be enough doctors to provide the best level of care at any one time and as doctors will be consistently overly tired.

The solution to anyone with a brain would be to hire more doctors and other healthcare professionals, rather than making everyone work more when they are already working their butts off!

The crux of the matter is that we have a monopoly of healthcare in the UK.  This, combined with the fact that we have a government which believes in neo-liberal capitalism to the max is going to result in the destruction of the NHS.

I saw a patient in A&E a couple of months ago who was brought in by ambulance because he had the worst neck of femur fracture I’d ever seen.  After I sorted him out and put him in a Thomas splint ready for theatre, he asked my opinion on what all this contract stuff was about.  I explained to him that basically if this contract goes through then a lot of doctors will leave the NHS, there will be a recruitment crisis, the NHS will become privatised and doctors will end up being paid more, much more.  It is odd that right wingers often moan about how much doctors get paid and how spoilt we are, while at the same time believing in a free market economy.  The market rate of a doctor = locum rate of pay for doctors fools!  Having medical skills is still a rare and valuable quality in the market.  So how can these people justify their stupid opinion the way they are so vociferously doing so in the news, media and comments sections of newspapers etc.?!

I know that this was a very long rant, but it is just astonishing to me that the English public do not realise what they are losing.  What do they think will happen in the near future?  I mean,  how many other employers do you know of that knowingly work its employees far more than their contracted hours?  Why do the public stand up for employees being paid below the minimum wage at Sports Direct but not stand up for unfair pay for doctors who save lives every day?  Is it fair that an A&E registrar gets paid the same hourly rate as a bus driver?   Is it safe for an employer to remove the safeguards which would ensure doctors are not overworked to the detriment of patients in a system which is already as exploitative as it is?

Rant over.

 

Quite an apposite video

Impact

I had a really interesting conversation with my girlfriend yesterday evening.  We are both Junior Doctors and not too far from finishing our postgraduate degrees when we will both become GPs.

We both became doctors to help others, create a better world and help people achieve their full potential through health care – in other words we wanted to have a big impact in the world.

When you become a doctor in the UK there are a limited number of routes you can take – you can either become a medical doctor, surgical doctor, family doctor etc.  However, none of these routes seem to have a big “impact” any more.  When I come home after a shift I rarely feel that I have made a real difference in another persons life.  Perhaps at most I may have played a small role in saving a life, but the feeling of having an impact soon disappears when the realisation that my role is easily replaceable in most life saving scenarios hits me.  So much of medicine now is following guidelines and literally doing your ABC’s (airways, breathing, circulation….) that medicine feels like it has become like a factory job and the patients feel like objects on the assembly line.  As a factory worker I am easily replaceable (by other doctors, resuscitation officers, nurse practitioners etc.) in many clinical settings.

Atul Gawande once wrote how in the 1930’s when a patient was admitted to a hospital there would pretty much be about two people looking after you.  That would be the doctor and the nurse.  In the modern day, this number has sky rocketed to about 70 people.  This includes a group of doctors from all different specialties, a group of nurses, pharmacists, porters, phlebotomists, radiologists, lab technicians, radiographers and so on.  This combined with the fact that medicine has become more of a tick-box job and following protocols and guidelines has meant that that feeling of having an impact as a doctor is at an all time low.

Naturally we asked each other; “well, how can we have an impact then?”.  I thought it was interesting that we both thought that having a medical education and some medical skills could actually still have a big impact in places with very little access to health care.  So, in places like rural India or parts of Africa, having more skilled professionals will make a massive difference to health outcomes and that must be a very fulfilling experience for clinicians who work in those parts of the world.  But, really neither of us thought that you could really make a big difference with traditional medical skills and knowledge in developed countries like the UK any longer.

It really seems that the future of healthcare will be through technology rather than practicing medicine in the more traditional sense.  There is no doubt that some technologies are already catching up to and surpassing what a human being is capable of.  For example doctors like Jack Kriendler are already on the cutting edge of what is capable with technology and have the vision to see what the future holds.  In his recent WIRED talk he spoke about how human instinct by doctors is often not questioned and is not evidence based.  Or, how software is already 15% better than the best radiologist at detecting whether something is a lung tumour or not on a chest x-ray.

Jack Kreindler speaking at WIRED Health 2015

Is it any wonder why Apple is investing millions into healthcare?  The need by people for on-demand healthcare with the best evidence available will only be achieved by using technology.

So really one has to ask whether continuing with the traditional medical pathway is in any way going to help me or my girlfriend reach our goals of having a fulfilling career.  It is likely that we will follow “non-traditional” pathways after our postgraduate training is over (such as combining medicine with research and travel or medical entrepreneurship)  rather than continuing.  This would allow us to live a more fulfilling life and will likely allow us to have a much bigger positive impact in the world.