Selling my DALYs for work

how medicine is actually killing us

We all know when our body feels well. So how do we end up with employment that hurts our physical and mental health?

One of the measurements of morbidity from illness that is globally measured as a DALY - or disability-adjusted life years. Some of the greatest impacts that are measured include chronic back pain and depression.

So why do physicians work in situations that affects our life-years?

Sleep deprivation is one of the key metrics. We all know the acute issues, that a post-call cognitive capacity is similar to drinking multiple alcoholic beverages. But the chronic implications of lacking consistent, restful sleep are significant. Life expectancy.

Same goes for stress levels. Our jobs deal with not just our own stress of maintaining clinic flow, accommodating unexpected situations, and unbearably long hours. But there’s also the vicarious trauma of dealing with people going through some of the worst life experiences collaboratively. All of the stress adds up. Elevated cortisol. Hypertension. Gastric acidity. Impaired immunity.

There is also something to be said for the isolation of it all. We can describe our lives to other physicians, especially if we have friends that we can be authentic and vulnerable with. But so few other people actually understand our job description. The sacrifices that we make—physically, psychologically, and socially. And that causes additional isolation.

So what do we do about this potential shortening of our lives, that we have committed in service of others?

We make them a meaningful as possible. We curtail the negative effects of the job. We ensure that we have agency and clarity around the work that we do, as much as we possibly can. Why is there an expectation that we work inhumane hours? Why is the expectation that we sacrifice our family and pleasure for the job?

When we show up in our full humanity, taken care of ourselves first, before we look after others, we will be better physicians. And we will be better physicians for longer...

My book The Modern Trauma Toolkit speaks to the effects of toxic stress in the body.