Dear First name,
 

My wife and I celebrated our 20th anniversary and welcomed our fifth child and first daughter in the month of July. It was a wonderful time for our family. However, a few days after Ella was born, amid the sleepless nights I learned a patient intended to file a lawsuit. It deflated my joy, and I could think of little else. Furthermore, even when not working, I had to respond to some insurance denials and handle several other burdensome tasks. Then, just 9 days after Ella was born, I went back to work and took call at the hospital.  I was not ready.  

I started back on a Friday and operated all day. I operated Saturday and Sunday. I operated until 7 pm on Monday. I then operated until 9 pm on Tuesday.  I also saw consults, answered messages from clinic and attended to several administrative duties. By the time I went to bed at 11:30 pm Tuesday, I was exhausted and felt burnt out.

 

The phone rang at 1:30 am. The ER doctor had a 36-year-old woman, who recently started using heroin, who had not been able to move or feel her legs for three days. She had no control of her bowel or bladder.  On her MRI, she had a large epidural abscess in her thoracic spine with spinal cord signal change.  

 

I looked at the images, then told the ER doctor there was little chance for the patient to regain neurological function. The patient needed surgery, but I would do it in the morning. A few hours wouldn’t matter.  I was tired, I thought to myself.  I needed the rest.  I was burnt out. Honestly, I didn’t feel empathy for the woman. I hung up the phone.

 

I’ve reflected on that moment for the last several months. How does a 36-year-old woman end up in such a horrible and dire situation?  Also, why did I feel the way I did?  After all, I went into medicine to help people—why did I feel so indifferent? 

Our society has seen incremental changes over the last several decades that have negatively impacted on our health.  The average American now spends over 7 hours per day looking at a screen, and 41% of American teenagers have a screen time of more than 8 hours per day.  Nearly 70% of calories in kids’ diets are derived from ultra-processed foods. On average we eat 17 teaspoons of added sugar per day, 3 times the recommended amount. Only 24% of adults meet the physical activity guidelines for aerobic and muscle-strengthening activities.  Those with chronic diseases have an even lower rate of exercise.  More than half of Americans get less than 30 minutes a day of exercise. An amazing fact of modern life is that we don’t have to move around to do anything. 100 years ago, people got five times more exercise every day, just during daily living.  

 

As a result of artificial and toxic substitutes for food and social connection, a lack of exercise and many other environmental and cultural factors we are burdened with diseases of metabolic dysfunction like never before.  The prevalence of obesity, a condition rarely seen 100 years ago, has been steadily on the rise.   Over 70% of Americans are overweight or obese. Half of American adults have pre-diabetes or diabetes.  30% of teens have prediabetes.  18% of teens have fatty livers.  Cancer rates are going up.  25% of American woman are on an antidepressant.  40% of 18-year-olds have a mental health diagnosis.  Other conditions such as infertility, autism, and autoimmune disease are rising.  About 90% of the annual 4.5 trillion health care expenditure is attributed to managing and treating chronic diseases and mental health conditions.  It seems we don’t have a healthcare system; we have a chronic disease management system.

 

The burden of disease has contributed to the burden on all of us.  Caregiver burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.  We saw burnout at a record-high 62.8% in 2021, and per the AMA was just below 50% on the day Ella was born, July 2.  We spend 43% of our time on data entry.  We only spend 28% of our time with patients. since 2001 Medicare reimbursement has declined 29% while the cost of running a medical practice has increased almost 50%.  We are working harder, taking care of sicker patients, for less.  

 

Perhaps disgruntled by and distrusting of overburdened caregivers, our patients are left seeking answers.  The global wellness economy was 5.6 trillion dollars in 2022.  Companies thrive selling products that advertise marvelous health advantages. Social media influencers and podcast hosts have popularized a contradictory menu of bio hacks, supplements, and rigid protocols.   Unfortunately, many of our patients turn to truly harmful quick fixes.  Drug overdose deaths in the US since 2000 are nearing 1 million.  Half of Americans 12 and older have used illicit drugs.  21.4% over the age of 12 have used illegal drugs or misused prescription drugs within the last year.  1.1 million Americans, including my patient, used heroin in the last 12 months.  

 

After I hung up the phone that night, I knew I should immediately take the patient to surgery.  Somehow, a deep sense of empathy and compassion came over me.  At 2:00 am, just before going back to the OR and after I discussed with the patient what we planned to do and likelihood she would not walk again, I realized the anesthesiologist for the case was the same anesthesiologist who re-positioned my wife’s epidural 2 weeks previously to the day also at 2:00 am. after 10 hours of labor. Ella was born 30 minutes later.  I told the patient, who was emotional and fearful, not to worry.  I knew from experience that her anesthesiologist does his best work at 2:00 am! I did not mention however that I do my best work during regular working hours!

 

During surgery, we evacuated a large abscess from the patient’s spine.  I arrived home at 4:00 am, slept for a couple of hours, then returned to the hospital.  When I rounded on the patient in the ICU, to my surprise, she was moving her left leg.  

 

Today, she is working to regain her ability to walk independently.  It was only after treating her that I discovered she too has a young child—a one year old she is working hard to make it back to.  It is an honor to serve our patients.  We see miraculous outcomes every day.

We need to recognize the environmental and cultural problems plaguing our health and our caregivers’ wellbeing. We need to see these issues, not as individual lack of willpower, drive, or self-control or a caregiver’s lack of work ethic and empathy but as community and system issues. It is hard for all of us to eat a healthy diet. It’s difficult to limit screen time. It can be a challenge to find time to regularly exercise. Many caregivers have experienced increased workloads, less autonomy, and less appreciation which is the very recipe for burnout.  In summary, it is hard to be healthy and help patients become healthy in America today.  

 

With the obvious decline in our health, we conclude no amount of money or treatment will overcome the current levels of metabolic dysfunction in our population.  Therefore, we need to change the paradigm.

 

Fortunately, health and longevity really doesn’t need to be complicated or expensive. Research has shown time and time again that exercise, nutrition, social relationships, and avoidance of harmful substances makes all the difference. 

 

This is the message I have for you today,

Dr. John Edwards