Monthly Archives: January 2022

Insomnia and menopause: a narrative review on mechanisms and treatments

Insomnia is the major menopausal problem I am presented with daily. I have had more blogs over the last 10 years on this topic, than any other. I am a firm believer in the benefit of Melatonin for insomnia, due to its safety and tolerability. It is just a matter of finding the right dose for best results.

Review Climacteric

Insomnia and menopause: a narrative review on mechanisms and treatments

P Proserpio  1 S Marra  2 C Campana  1 E C Agostoni  1 L Palagini  3 L Nobili  2   4 R E Nappi  5 Affiliations


The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.

Hormone Therapy in Menopause

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Review Adv Exp Med Biol

2020;1242:89-120. doi: 10.1007/978-3-030-38474-6_6.

Hormone Therapy in Menopause

John Paciuc  1 Affiliations


As longevity expands, women are spending a third of their existence in menopause and beyond. The vast majority suffer from symptoms that negatively impact their quality of life. Systemic vasomotor symptoms (VMS) are the classic cluster affecting 80% of peri- and post-menopausal women. Once thought to be relatively brief, they sometimes persist more than 10 years. Compelling, yet enigmatic, is the recent finding that women with bothersome and long VMS compared with age-matched peers often have worst underlying preclinical markers of cardiovascular disease (CVD).Local vulvovaginal and urinary symptoms, now termed genitourinary syndrome of menopause (GSM), are seen in 50% of postmenopausal women, and it negatively impacts quality of life. Estrogen remains the most effective treatment for both VMS and GSM, for osteoporosis prevention, and for symptom relief as well as chronic disease prevention in women who experience premature menopause whether from primary ovarian insufficiency (POI) or iatrogenic etiologies. For women who have contraindications to estrogen therapy or who personally object, a panoply of nonhormonal modalities can be offered to treat both systemic and local menopausal symptoms. A historical review of estrogen studies reveals why its persona has vacillated from hero to villain (after the WHI) and back to hero. The “timing hypothesis” and its underlying mechanism shed light on the pleiotropic nature of estrogen. Finally reviewed is the compelling argument from notable thought-leaders that estrogen, in those without contraindications, should be considered for primary prevention of cardiovascular disease as well as the prevention of chronic disease.

Kids whose grandparents are overweight are almost twice as likely to struggle with obesity


Kids whose grandparents are overweight are almost twice as likely to struggle with obesity

January 21, 2022 1.39pm AEDT


  1. Edmund Wedam Kanmiki PhD Candidate, The University of Queensland
  2. Abdullah Mamun Associate Professor, The University of Queensland
  3. Yaqoot Fatima Senior Research Fellow, James Cook University

Disclosure statement

Edmund Wedam Kanmiki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Abdullah Mamun receives funding from NHMRC, ARC, Queensland Health, and Health and Wellbeing Queensland.

Yaqoot Fatima received funding from NHMRC, MRFF, Western Queensland Primary Health Network, Tropical Australian Academic Health Centre, Queensland Health, and Health and Wellbeing Queensland. She is a member of the Indigenous Sleep Health Working Party of the Australasian Sleep Association.


James Cook University and University of Queensland provide funding as members of The Conversation AU.

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School holidays can be a special time for extended families to gather. Children may see their grandparents at seasonal gatherings or as part of childcare arrangements to help working parents. New research suggests the biology, environment and the food they share contributes to children’s future health.

According to the World Health Organization, 39 million children under five years are overweight. Some 25% of Australian children and adolescents are overweight or obese.

How parents contribute to their offspring’s obesity risk is well established but the link between grandparents and grandchildren has been less clear. Our systematic review of studies involving more than 200,000 people around the world confirms obesity is transmitted across multiple generations of families. We still need to figure out why and how to break this cycle.

Read more: 4 ways to get your kids off the couch these summer holidays

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Setting up for a lifetime of health issues

Obesity among children and adolescents is associated with developing health problems. These include high blood pressure, cholesterol imbalance, insulin resistance, diabetes mellitus, accelerated growth and maturity, orthopaedic difficulties, psychosocial problems, increased risk of heart disease and premature mortality.

We examined the current global evidence on the association between grandparents who are overweight or obese and the healthy weight status of their grandchildren. We looked at 25 studies that involved 238,771 people from 17 countries. The combined data confirms obesity is transmitted multigenerationally – not just from parent to child but also from grandparent to grandchild.

We found children whose grandparents are obese or overweight are almost twice as likely to be obese or overweight compared to those whose grandparents are “normal” weight.

Read more: Should we ban junk food in schools? We asked five experts

Nature and nurture?

Further research is needed into how children’s obesity status is influenced by their grandparents but there are likely two pathways at work. The influence could be indirect via parents’ genes or occur directly through the roles played by grandparents in children’s upbringing.

Let’s start with biological factors. Both egg and sperm cells contain molecules that respond to the nutritional intake of parents. This means traits that are susceptible to high weight gain can be passed on from grandparents to parents and then to their grandchildren. And evidence shows genetics, environmental factors, lifestyle and eating habits all play key roles in predisposing individuals to obesity.

What we eat and feed our family members can lead to the expression of certain genetic traits (a term referred to as epigenetics) which can then be transferred to successive generations. Due to shared familial, genetic, and environmental factors, obesity tends to aggregate within immediate families and studies have consistently reported an intergenerational transmission of obesity from parents to children.

Food intake can also influence health and biology across multiple generations. In Sweden, a study reported adequate food for paternal grandparents at ten years of age reduced heart disease and diabetes and increased longevity among their grandchildren.

baking cupcakes pulled from over by adult and child
Grandparents’ influence on their grandchildren’s obesity risk may be biological or a result of dietary choices. Shutterstock

Food and family

So, grandparents’ weight status and choices about what and how much is eaten in their home could influence their grandchildren’s weight directly or via the children’s parents. These influences may be greater or less significant depending on the role grandparents play as primary care givers or in shared living arrangements. According to the recent Australia’s Seniors’ survey, one in every four Australian grandparents provides primary care to their grandchildren.

Grandparents’ role as caregivers significantly affects children’s healthy eating knowledge, attitude, and behaviours. This might be seen in the meals shared, recipes passed down or special treats for loved ones. Such habits can add to childhood obesity risks, above and beyond genetic factors.

family table with older man feeding young child
Grandparents regular provide childcare and therefore meals. Shutterstock

Read more: More than one in four Aussie kids are overweight or obese: we’re failing them, and we need a plan

Working on prevention

Our research shows the importance of including grandparents in obesity prevention strategies. In addition to parents, grandparents could be oriented to provide guidance on responsible feeding, recognising hunger and fullness, setting limits, offering healthy foods and using repeated exposure to promote acceptance. They can help encourage regular exercise and discourage coercive feeding practices on their grandchildren.

While our study shows a multigenerational link in the transmission of obesity, most of the available evidence comes from high-income countries – predominantly America and European countries. More studies, especially from low-income countries, would be helpful.

Further investigation into the effect of grandparents on grandchildren’s obesity across different races and ethnicities is also needed. Grandparents have varied social and cultural roles in the upbringing of their grandchildren around the world. More data could help design effective obesity prevention programs that recognise the vital importance of grandparents.

What’s autophagy? It’s the ultimate detox that doesn’t yet live up to the hype

What’s autophagy? It’s the ultimate detox that doesn’t yet live up to the hype

January 12, 2022 6.12am AEDT


  1. Tim Sargeant Head, Lysosomal Health in Ageing research group, South Australian Health & Medical Research Institute
  2. Julien Bensalem Postdoctoral researcher, Lysosomal Health in Ageing research group, South Australian Health & Medical Research Institute

Disclosure statement

TJS and JB are listed as inventors on a related patent, PCT/AU2020/050908 for measurement of autophagy in humans.


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“The anti-aging MIRACLE.” “Strengthen your immune system.” “Lose weight fast.”

These are some of the promises of autophagy, the silver bullet wellness influencers are saying is backed by Nobel-winning science.

In many cases, influencers say the best way to boost autophagy – the body’s way of recycling molecules – is with a product available from their online store.

While autophagy sounds too good to be true, the scientific reality may cross over with the hype – at least in laboratory mice and some other organisms.

Get your news from people who know what they’re talking about.

Here’s where the science is up to and what we still need to find out to see if boosting autophagy helps humans.

Read more: Research Check: can eating aged cheese help you age well?

Autophagy is the ultimate detox

Autophagy is a vital process that removes and recycles unwanted or damaged molecules from your cells.

The process begins with the cell marking unwanted or damaged organelles (made from molecules like proteins, carbohydrates, lipids, and DNA or RNA) for removal.

These marked organelles are enveloped by a membrane, sealing them inside like a garbage bag, becoming what scientists call an autophagosome.

The autophagosome then moves closer to another organelle called a lysosome, a small acidic bag filled with powerful enzymes. When the two fuse, their contents mix. The enzymes break down the rubbish into recycled nutrients your cells can re-use.

It is the ultimate detox, and you’re doing it right now.

How autophagy works in the body. Created with Author provided

Mice benefit, but do humans?

Removing these waste products can potentially affect age-related diseases. For example, genetically engineered mice with less autophagy are more likely to develop tumours. Decreased autophagy also accelerates signs of dementia and heart disease in mice.

Autophagy degrades cellular components to re-use as an energy source during advanced stages of starvation in mice. And because autophagy is crucial for survival during starvation, it is sensitive to nutrient and energy levels. If we decrease nutrition in laboratory cells and laboratory animals, autophagy increases to compensate. This means diet can potentially modify autophagy.

It all sounds promising. But, and this is the big stumbling block, we don’t really know how it acts in humans.

Read more: Of mice and men: why animal trial results don’t always translate to humans

How would we know if it’s the same in humans?

For us to know if fasting, taking a pill or some other activity affects autophagy in humans (and our health), we need to be able to measure if autophagy is increasing or decreasing.

And our group has developed the first test of its kind to measure how autophagy activity varies in humans. But even that is limited to blood samples. We’re still not sure about the levels of autophagy in tissues like the brain or whether the autophagy activity we see in the blood matches elsewhere in the body. We are working on it.

Read more: There’s no magic way to boost your energy. But ‘perineum sunning’ isn’t the answer

How about those diets or pills then?

We simply do not understand enough about autophagy in humans, and there has not been enough time to test whether autophagy-boosting diets or supplements actually work in people. At best this makes various claims of boosting autophagy and its benefits premature, and at worst, completely incorrect.

Given the positive results in animals, and because autophagy is sensitive to nutrition, it is not surprising there is no end of advice and nutritional supplements that promise to increase autophagy for healthy ageing.

These tend to be books or material that explain how to diet your way to more autophagy (using intermittent fasting or keto-diets for example). Or, you can buy supplements claiming to increase autophagy with ingredients such as citrus bergamot.

Woman holding up dietary supplement
There is no end of advice and nutritional supplements that promise to increase autophagy for healthy ageing. Shutterstock

As dubious as these claims might seem, a lot of them do tend to stem from a grain of truth. Indeed, work on the mechanisms of autophagy really did win the Nobel Prize in 2016.

But influencers’ claims wildly extrapolate from preliminary data without context. For example, a mouse can only go without food for two to three days before dying, while a human can go without food for weeks.

So exactly how much fasting is required to increase autophagy in humans is completely unknown: influencer claims of 16, 24 or 48 hours are stabs in the dark.

This is equally true for supplements. One prominent product for sale is spermidine, which can increase autophagy in the laboratory, such as in yeast and cultured human cells. However, nothing directly shows it can increase autophagy in humans.

Autophagy has only been widely studied for around 15 years. So far, we know it can slow biological ageing in laboratory animals. Because of this, it has the potential to address some of the biggest health issues our society currently faces. This includes dementia, cancer and heart disease.

But, at the moment, we just don’t know enough about autophagy in humans to make any claims about what we can do to increase it, or any health benefits.

Ben Lewis, science writer and communicator at the South Australian Health and Medical Research Institute, co-authored this article.

Natural sleep-enhancement methods physicians can use tonight

Natural sleep-enhancement methods physicians can use tonight

Richard Chachowski|January 4, 2022

Few things are more restorative than a quality night of sleep. The recommended 7-9 nightly hours of shuteye are essential for attention acuity, cognitive adroitness, swift reaction times, and mood stabilization—all qualities you’d probably prefer to have in spades as an HCP. 

Research has shown that exercise helps to calibrate the body’s natural ebb and flow of energy levels.

Unfortunately, many of you are working overtime. According to the Physicians Foundation’s 2018 Survey of American Physicians, doctors work anywhere from 41-60 hours a week, while the national average stands at 34.7 hours. That extra work often translates to sleep deprivation. According to a 2018 Journal of Community Health study, about 45% of healthcare workers sleep fewer than 7 hours nightly. Healthcare was second only to protective service and military, of which 50% sleep fewer than 7 hours.

Not getting enough sleep can take a serious toll on your health, with a 2016 Current Opinion in Cardiology study showing that inadequate sleep is associated with weight gain, inflammation, cardiovascular disease, diabetes, and early mortality. It can also undermine judgment, mood, and cognitive abilities, and cause heightened stress. A 2020 JAMA Network Open study found that physicians with high levels of sleep deprivation were 97% more likely to self-report a serious medical error. And, according to a Sleep Health study, nurses who slept fewer than 7 hours before a work day were similarly found to have lower ratings of quality of care and patient safety.

The case is clear: If you want to be a more effective HCP, you need to improve the quality and duration of your sleep. While pharmaceuticals are an option, some may prefer to first try more natural methods. The following natural approaches are clinically validated. 

Exercise regularly

Physical activity is obviously important for a variety of reasons, but exercising on a regular basis can also affect how tired you feel at the end of the day, paving the way for restorative, uninterrupted sleep when you finally turn in.

A 2017 Advances in Preventive Medicine review found a correlation between people with higher levels of regular physical activity and better sleep, especially for older individuals. That raises the question of what types of physical activity benefit sleep. For people diagnosed with insomnia, a 2019 Brazilian Journal of Psychiatry study found that moderate resistance training and stretching led to objective and subjective sleep improvements, lengthier sleep durations, decreased waking episodes during the night, and generally less stress and tension overall.

Drink herbal or decaffeinated tea

It’s impossible to pinpoint one simple explanation for why many HCPs receive insufficient sleep, but it’s likely some combination of stress and variable hours/shift work. Some herbal or decaffeinated tea may take the edge off both.

A 2020 Complementary Therapies in Medicine study found that lavender tea reduced anxiety and depression scores among the elderly (an at-risk group for depression and anxiety), making it an effective tea choice to unwind with. Chamomile is another option. A 2019 Phytotherapy Research meta analysis found that chamomile extract also improves overall sleep quality, with a limited 2016 Phytomedicine study reporting long-term chamomile consumption was effective in combating moderate to severe generalized anxiety disorder. 

No matter your tea choice, be sure you choose herbal or decaffeinated. According to the American Academy of Sleep, caffeine has a half-life of 3-5 hours, meaning a cup of late afternoon coffee could affect your ability to fall asleep at night. To make it easier to sleep at the end of the day, avoid caffeine or sugar before bed—including caffeinated teas, sodas, chocolate, and other sweets.

Read or listen to music before bed

A relaxing evening routine can ease the transition into sleep. Try reserving an hour before bed for “quiet time,” wherein you avoid strenuous exercises and artificial light. A 2017 Chronobiology International study found that bright screens—from phones, TVs, and computers—negatively affected melatonin secretion, disrupted sleep patterns and morning attention, and resulted in daytime drowsiness.

To avoid that wakefulness, turn off screens before bed and opt for reading a book, listening to calming music, or doing yoga or breathing exercises to reach a relaxed state of mind that will help you slip more easily into la-la-land.

Take a hot shower or bath

Cold and hot showers each have their own benefits—cold water being beneficial for circulation, boosting metabolism and improving recovery—but in terms of getting ready for bed, we suggest a hot shower an hour or so before lights out.

A 2019 meta-analysis in Sleep Medicine Reviews found that taking a hot shower or bath improved overall sleep quality, and that those who showered/bathed 1-2 hours before bed had shorter sleep onset latency (SOL). A 2021 Journal of Clinical Sleep Medicine study similarly found that older adults who took a hot bath 1-3 hours before bed had decreased SOL rates as well.

Researchers behind a 2020 study in Current Opinion in Physiology have attributed hot showers to aiding the body’s thermoregulation process. By immersing yourself in hot water, you’re speeding this process along, meaning shortened SOL levels and an easier time falling asleep (a phenomenon known as the “warm bath effect”).

Set a strict sleep schedule

HCPs may have chaotic work schedules, but it’s critical that you maintain a healthy balance between wakefulness and sleep. To do so, you can start by supporting your natural circadian rhythm.

Evidence-backed ways to cut dementia

Evidence-backed ways to cut dementia

Naveed Saleh, MD, MS|June 2, 2021

On the surface, dementia statistics are harrowing. Globally, about 50 million people live with dementia. By 2050, this number is projected to rise—especially in low- and middle-income countries in which two-thirds of those with dementia currently live. Furthermore, the financial impact is expected to be about $1 trillion annually.

Exercising regularly is just one of a dozen modifiable risk factors for dementia, according to new research.

These numbers are staggering, according to the authors of a 2020 update of the 2017 Lancet Commission on dementia prevention. The good news is that dementia is not necessarily a foregone conclusion as we age. In fact, neurocognitive health is highly dependent on many lifestyle decisions that we can control.  

The Lancet study authors point to 12 modifiable risk factors fleshed out by the research—an increase from the nine cited in 2017. Let’s take a closer look.

What can be done?

According to the Commission, the 12 modifiable risk factors account for about 40% of worldwide dementia that can be prevented or delayed.

The authors categorize prevention strategies as: 1) reduced pathological damage (eg, amyloid-/tau-mediated, vascular, or inflammatory mechanisms), and 2) increased/maintained cognitive reserve.

The authors cite the following interventions:

  • Reduce diabetes
  • Reduce hypertension (ie, systolic pressure of 130 mm Hg at 40 years or older via antihypertensive medications)
  • Avoid head injury
  • Stop (or don’t start) smoking 
  • Decrease exposure to air pollution (including second-hand smoke)
  • Decrease midlife obesity

Additionally, the authors recommend the following for maintaining/boosting cognitive reserve:

  • Treatment of hearing impairment (ie, use of hearing aids and avoidance of excessive noise levels)
  • Develop and maintain social contact
  • Attain higher levels of education

As for factors that relate to pathological damage and cognitive reserve, the authors recommended the following:

  • Engage in frequent exercise
  • Address depression
  • Avoid excessive levels of alcohol

Of note, the three new modifiable risk factors added in 2020 were excessive alcohol consumption, head injury, and air pollution.

The authors wrote, “We recommend keeping cognitively, physically, and socially active in midlife and later life although little evidence exists for any single specific activity protecting against dementia …. Although behaviour change is difficult and some associations might not be purely causal, individuals have a huge potential to reduce their dementia risk.”

They added, “Well-being is the goal of much of dementia care. People with dementia have complex problems and symptoms in many domains. Interventions should be individualised and consider the person as a whole, as well as their family carers. Evidence is accumulating for the effectiveness, at least in the short term, of psychosocial interventions tailored to the patient’s needs, to manage neuropsychiatric symptoms. Evidence-based interventions for carers can reduce depressive and anxiety symptoms over years and be cost-effective.”

Other recent research suggests that sleep deprivation can lead to certain types of dementia. Read more about it on MDLinx.

Do these preventive strategies work?

Results of a prospective study published in the BMC reflected whether the 12 aforementioned modifiable risk factors decreased the incidence of dementia diagnosis in 1,100 participants within the study period (mean follow-up, 82.3 months). The researchers also controlled for nonmodifiable risk factors including age, sex, and APOE ε4 genotype.

Overall, 10.1% of the sample developed dementia, with APOE ε4, diabetes, heart disease, stroke, and delirium all independently correlated with risk of dementia. In the present study, nearly 40% of dementia cases were secondary to comorbid diseases.

It’s Just Not Fair.

A year ago medicare stopped giving rebates for telephone consultations. To qualify for a rebate you must have seen the doctor face-to-face (FTF) within the year before the telephone consultation. This is totally unfair to people who live in regional/rural areas, who are patients of doctors like myself, who have skill not available locally. If you live near here, Caloundra or North Lakes say, it is not too difficult to make a FTF appointment. If you live at Chinchilla, or Mackay for example, it is not so easy. You may be facing an 8 hour journey one way. How wise is this in the time of Covid, anyway, when we are encouraged to stay home. Some of my regional patients have been seeing me for more than 20 years. So again, country people are being punished again. What bureaucrat thought up this dumb policy.

I suggest rural people contact their local representatives and point out how unfair this is. There is an election coming up, so this may be a good time to get noticed. If enough people complain, this unjust rule may be corrected.

You should care about your doctor’s health, because it matters to yours

This is my first post of the new year. Unfortunately, Covid is still very much present and we will just have to get on with it. I continue to work as usual. I am not taking any new patients at present (Avoiding burnout) but hope this will be able to change in the near future. Jeff, the pharmacist at the Compounding Clinic next door has left for greener pastures, and we wish him well. My fees have gone up slightly, which is the first time in 4 years. This is due to the cost of running a medical practice having escalated (Like most other things). I wish you all well and hope this will be a good, healthy and Covid free year.

You should care about your doctor’s health, because it matters to yours

June 8, 2017 12.27pm AEST Updated February 28, 2019 9.15am AEDT


  1. Alex Broom Professor of Sociology, UNSW

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Alex Broom receives funding from the Australian Research Council


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Doctors’ health tends to be broadly high compared to the general population. This is expected given their relative privilege. Health operates according to a social gradient – those with more, say, money and education, generally do better and live longer. Yet, among doctors, suicide rates are disproportionately high and mental illness is common.

Our society tends to consider certain people or roles as privileged and resilient. Doctors, above all, are helpers: they care for us, rather than us caring for them. Large salaries, influence and cultural deference lead us to assume they are not in need of care themselves.

Such assumptions are not helpful if we want to address the problem of poor well-being in the medical profession. Research shows doctors are prone to burnout, depression, anxiety, substance abuse problems, and dysfunctional personal relationships.

And when doctors struggle, the human side of the care they are trained to give suffers, and so do we as patients. Ensuring doctor wellness should be seen as ensuring quality in the Australian health-care system, promoting competence, reducing medical errors and, in turn, ensuring health system cost-effectiveness.

Get your news from people who know what they’re talking about.

Doctors who feel better will make fewer mistakes and solve problems faster. Our public investment in their careers will pay off with quality care.

Doctors’ well-being and patient health

There are many examples of the impacts of a doctor’s health on the patient. Empathy, for example, is crucial to clinical competence. We know people have more empathy when they are feeling better themselves.

The current environment may in many cases promote the reverse – what is often referred to as decreased presenteeism, or on-the-job productivity. Doctors may be present (in the clinic) but not engaging with their patients.

Read more: Are our busy doctors and nurses losing empathy for patients?

Medicine is a quickly evolving science. Doctors are required to constantly absorb new and complex information. A recent review of studies, for example, showed participation in continuing education improves professional practice and, crucially, patient outcomes.

Further, there is a known negative relationship between participation in professional education and burnout. This means the more stressed the doctor, the less motivated they will be to learn new things, and the less capable they will be to care for us.

In many other professions, time in the job reduces the risk of burnout. After an adjustment period that might be stressful, people settle down. In medicine, being in the job longer actually increases risks. The long hours, work-life imbalances, workplace pressure and even recent changes in employment opportunities fundamentally bring into question the assumed privilege of doctors.

Our study of cancer doctors

Our recent study revealed how cancer specialists experience some of these issues.

A junior cancer specialist told of the pressures cascading through medical school to training:

… you get through medical school, you do your internship residency, you get through and you don’t fail, and that’s one … then you do your physician training … it kind of takes over your life … and then you find yourself in a medical oncology advanced training position, then you’re like, ooh, everyone’s talking about there being no job, and you just think, ‘Gosh, I’ve just put myself through the wringer for the last ten years of medical school and then physician exams and everything’ … You just think, ‘Oh my god, it doesn’t end.’

Another said:

…If you’re skating on the edge of burnout, then it is very difficult to have patience with patients and their families … you’re not going to have that reserve and resilience…

A medical culture of not talking about emotional problems was also evident:

There’s not very many clear avenues of people that we can talk to about when there are difficult situations … that is something which has the ability to affect your mental health in a detrimental way … It still becomes hard for any individual to admit that they’re struggling with something because that may come across as a form of weakness.

And an early-career cancer specialist talked of how on-the-job pressures affected patient care:

I think you need to be able to commit that time [to patients] in order to be doing an effective job and if [treatment] becomes a box-ticking exercise … it dehumanises the relationship, which I find a struggle … When there isn’t time to see everyone and you have to rush them out, I think that really wears down that important part of the patient-doctor dynamic.

Not just ‘doctors’ personalities’

A classic opt-out in this debate is that doctors are type-A personalities, which means they are competitive, self-critical, high achievers and so on.

While this may be true for some, viewing the problem through this lens places the responsibility on doctors themselves rather than focusing on systemic cultural and organisational issues in medicine. It also contributes to the cultural tendency to individualise mental health issues, rather than see them as deeply embedded in broader professional and health service problems.

Medical care is rarely straightforward. It involves listening to patients’ stories, putting together complex histories and, in many cases, managing the difficult emotions of patients and families.

If we want doctors to listen, be empathetic, solve complex problems and maybe even save the health system money, we need to invest seriously in clinician well-being. Healthy doctors understand us better, make good decisions and offer us the best chance of good health.