Quality of Life

By John J. Nava, MD, 2023 BCMS President

“When I was 5 years old, my mother always told me that happiness was the key to life. When I went to school, they asked me what I wanted to be when I grew up. I wrote down ‘happy’. They told me I didn’t understand the assignment, and I told them they didn’t understand life.” – John Lennon

Up until seven years ago, I had been unfamiliar with this quote attributed to the famous Beatle, content to be swept away by his lyrics and music, which I heard as a young child. I was first exposed to it during a trip to Central Park in New York City with my son, Joshua. He had never been to the Big Apple, and I had visited only once before. My previous visit was for a weeklong National Hispanic Medical Association (NHMA) conference, with a schedule so tightly packed that I had little time for sightseeing. Spring Break seemed the perfect opportunity to return to visit Strawberry Fields. A street vendor provided the quote on a small card, which I snatched up and framed for my office, as a reminder.

Webster’s dictionary provides a few definitions for quality of life (QoL), “overall enjoyment of life, general well-being; specifically: the degree to which a person or group is healthy, comfortable, and able to enjoy the activities of daily living.” This term was first known to be used in 1943. Multiple components impact QoL, those being health, emotional wellbeing, personal safety, social relationships, belonging, work and quality of environment.

Financial wellbeing completes the list, though higher incomes do not always correlate with higher QoL. By definition, the term is nebulous and invites confusion with the standard of living, which is a much more easily quantified concept, typically an assessment of financial resources and other material tools to achieve satisfaction in life.

This is truly significant for patients and physicians. In the case of patients, health related quality of life (HRQoL) is a measurement of the same indices specifically affected by health and health interventions. These are reflected in levels of self-reported satisfaction with their current health plan, clinic site, PCP and associated support staff. Other clinical measures, such as whether they work together with the clinical team to follow evidence-based best practices for prevention, are data driven and typically inform the quality assurance gurus (which we are all encouraged to become).

Of course, patients can always decide to obtain their healthcare services from a different company, clinic or physician if their needs are not met. When it comes down to it, the patient is in control, which is as it should be. Without the cooperation of our patients, we are much less.

QoL for physicians has gotten much recent attention, as healthcare workers are leaving the field in droves. It is truly a challenge for the healers to attend to others when they don’t start with fully charged batteries themselves. For physicians, it is a natural choice to try and pay off student loans, buy a house and start or continue to build a family. Younger newly graduated physicians should carefully examine their future financial plans. All costs should be included, especially the intangible ones. Maybe even mid-career colleagues can do the same.

During the Covid-19 pandemic, increased rates of clinician burnout, symptoms of anxiety and depression, and suicide rates have been noted. In response to these phenomena, physician coaches are leading the medical profession to respond with an emphasis on self-care and prevention of mental health issues. Whether this new awareness is related to the ongoing pandemic or past neglect of the antecedents of symptomatic mental issues, it is an opportune time to address them. I recently came across a post by a physician who was burned out by active clinical primary care, and had developed side employment as a hospice physician, financial advisor and writer. He wrote a book about the perspectives of his hospice patients as they neared the end of life, and was surprised that none of them expressed regrets that they had not worked harder or for more money to leave to their survivors. I suspect they wished they had spent more quality time with their families, nurtured the relationships with people that brought them joy, exercised more to enjoy better health, developed better sleep habits and spent more time experiencing nature. I am looking forward to reading that book.

With regard to preventing mental health issues for physicians, some might ask, they knew the many years of education would be difficult, the hours grueling and the needs endless, right? Perhaps, but under- neath the armor, we are people too. And despite perhaps being more resilient at the start of our careers, it’s possible we didn’t acquire the requisite skills to meet all the challenges never planned for. I was trained by a number of “iron men”, (both male and female) who inculcated the belief that asking for help was a sign of weakness. The only thing to do when you got stuck in the mud was “pull yourself up by your own bootstraps!” This is Texas, so I could not resist the boot analogy, but hope it is becoming an outdated concept when applied to mental health. Of note, “primary care practices with zero burnout are more often solo practices owned by physicians and practices not involved in transformation initiatives, such as accountable care organizations (ACOs).”1 Quality assurance efforts are wonderful tools, but when added to an already busy day, clinician stress and burnout may spill over to affect patient centered care.

It is never too late. I encourage all my colleagues to question their version of reality, where they have been and where they are going. If they don’t like what they see, they can actively change it. Or, if they do like what they see, share your story with your colleagues. Starting small to create a new work-life balance can lead to widening the vision. Even the smallest change can be empowering to make a better future for yourselves and your loved ones.

References

1. FamilyPractice News, Vol. 15, No.7, p. 8. July 2021, citing Health Affairs, (2021.doi:101377.hlthaff.2020.02391.

John J. Nava, MD, is the 2023 President of the Bexar County Medical Society. He is interested in Primary Care, Clinical Research and Public Health.