Joseph R Hageman, MD

As you may already know, Charles Dickens had an amazingly active mind. One of the quotes from the book entitled ‘The Daily Charles Dickens A Year of Quotes’ by James R Kincaid, in a letter to his close friend, confidant and financial advisor, John Forster, summarizes his own view of his life: “ however strange it is to never be at rest, and never satisfied, and even trying after something that is never reached, and to be always laden with plot, plan, care, and worry, how clear it is that it must be…it is much better to go and fret, than to stop and fret. As to repose-for some men, there is no such thing in this life”. Letter April 13, 1856. (1)

As you may know, Dickens would take long walks through different parts of the city of London at night, then come home and write down his observations of people and places. These were his thought and ideas for his books and the characters in them.

Before he started his writing routine at 8 am, he made rounds to the children’s rooms to make sure that everything had been cleaned, made, and appropriately placed. He made a list of those that had not been accomplished and presented them to each of the children. He really loved his kids, but he also had certain expectations as well. I think this quote by Dickens himself, and some of his behavior is consistent with “type A personality described by Freedman and Rosenman originally, who were cardiologists (2). The definition of type A personality is presented in Mosby’s Medical Dictionary: “a parent ego state characterized by a behavior pattern described by Meyer Friedman and Ray
Rosenman associated with individuals who are highly competitive and work compulsively to meet deadlines. The behavior also is associated with a higher than usual incidence of coronary heart disease.” (3)

We can also surmise that Dickens had an element of obsessive compulsiveness or obsessive-compulsive disorder (OCD) as well. It is clear that there is a spectrum of OCD behaviors. (4)

How many of you describe yourself in your self-assessment as a “type A” and maybe having a bit of “OCD”? I know I have characteristics of both of these “disorders” when I was in clinical practice as a neonatologist, pediatric intensivist, apnea doctor, and the head of inpatient pediatrics. In what I am doing now as director of NICU quality improvement and a resource person for the NICU nurses, NNPs, medical students, residents, fellows, and faculty, as you might guess, I still am “type A” and have some OCD characteristics in “semi-retirement.”

Why am I writing about Dickens as a famous example? Why am I also using myself as an example? I think it is safe to say that many of us in medicine — and I am not just talking about physicians, but also nurses, NNPs, physician assistants as well have these personality characteristics. As you may have noted in the Mosby definition, people with “type A” personality have a higher risk of coronary artery disease. Guilty as charged in my case including the “cardiac arrest or heart attack” with 10 minutes of ventricular fibrillation requiring five shocks to convert. This was followed by a four-vessel bypass and cardiac rehabilitation. I swam laps seven days a week and had been for about 20 years. BTW, status post vagotomy and pyloroplasty 31 years ago and a recurrence of cervical dystonia with q 3 month, botox injections. Enough!

This is another opportunity for you to take a few minutes every day of the week to take care of yourself and “be mindful.” Mindful meditation, guided imagery, body scanning are all forms of simple, not time-consuming forms of mind-body therapy (5). If I can learn these and make them an automatic part of my day, so can you. All of this discussion in the literature about physician wellness and resilience is important for all of us to help prevent burnout (6). There were about 300 physician suicides reported last year (or maybe two years ago) in the United States. (7) Women appear to be at great risk. There is a definite risk for depression, as well. In medicine, we are all working in a stressful environment, and each of us develops a method or strategy for dealing with chronic stress. Our work also has an effect on our personal lives as well.

Dr. Hilary McClafferty and I just recorded a “physician resilience” podcast in which I discuss my strategies for dealing with the stress that we experience professionally. Hilary is a pediatric emergency physician and integrative medicine physician who is the first author on the physician wellness curriculum for the American Academy of Pediatrics (AAP). (8) We are working to help people in medicine with the challenges we face in our professional lives.

References:

1. Kincaid J. The Daily Charles Dickens: A Year of Quotes. University of Chicago Press., 2018.
2. McLeod S. Type A and B personality. https://www.simplypsychology.org/personality-a.html
3. Mosby’s Medical Dictionary, 9th edition. © 2009, Elsevier.
4. The National Institute of Mental Health (NIMH) (January 2016). “What is Obsessive-Compulsive Disorder (OCD)?”. U.S. National Institutes of Health (NIH). Archived from the original on 23 July 2016. Retrieved 24 July 2016.
5. McClafferty H. Mind body therapies. In Integrative Pediatrics. New York: Routledge, 2017. P.73-103.
6. McClafferty H. Self care: Cultivating healthy resilience.. In Integrative Pediatrics. New York: Routledge, 2017. P.16-28.
7. Anderson P. Physicians experience highest suicide rate of any profession. https://www.medscape.com/viewarticle/896257
8. Hilary McClafferty, Oscar W. Brown, SECTION ON INTEGRATIVE MEDICINE, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE. Physician health and wellness. Pediatrics, Oct 2014, 134 (4) 830-835.

The author has identified no conflicts of interest.