AAP Voices Blog

As a pediatric intensive care physician, my patients’ needs come first. And I know this is the norm for many other doctors as well.

We resuscitate a victim of child abuse and forego lunch. We discuss a complex case with a doctor at a community hospital before we find time to drink some water. We answer parents’ questions as we sit vigil with their child and delay a much-needed bathroom break.

We are taught to consider ourselves invincible and to be seen as invincible. We wear “no sleep/no food” as badges of honor. My specialty certainly is not unique in these behaviors.

By the end of the day, there is often little time or energy left to address our own needs. To keep ourselves fed and marginally rested takes perseverance. We have to really work at it. In addition, many medical offices are not open when we start our shifts and have closed by the time we finish work, making it difficult to schedule checkups and recommended screenings.

We are apt to neglect our own health.

In 2011, a report published in Occupational Medicine looked at 27 studies and found that self-treatment was a significant issue for physicians and medical students. In 76% of the studies, more than 50% of the physicians reported self-treatment. A Canadian study found that physicians are 60%-85% compliant with preventive screening.

“Give yourself the same consideration you give your patients. Keep up to date on your preventive care. Make the appointment for your annual well exam.”

In a recent Harris Poll of about 300 family medicine and internal medicine physicians in the U.S., 80% of physicians who responded said practicing self-care is “very important” to them personally, but only 57% practice it "often" and about one-third do so only “sometimes.”

My own experience over the last two years has taught me that we all must be active in our own preventive care, and I hope my story can encourage others to do so.

In 2018, I had a Loop Electrosurgical Excision Procedure (LEEP), to remove abnormal squamous cell cervical growth recognized on an annual well woman screen. However, not only did the pathology show abnormal squamous cell growth, it also showed another type of abnormal glandular cell called cervical adenocarcinoma in situ (AIS). This is a pre-cancer that can lead to invasive cancer if left unchecked.

I remember the phone call to share the diagnosis vividly -- the universe stopped while I considered my own risk for having the dreaded C word.

AIS is tricky and has seen increased incidence in recent decades. It can have skip lesions outside of surgical margins and has a risk of recurrence. The gold standard for AIS is ultimately a hysterectomy, but at the time of my diagnosis, I was single and without children. I asked to see a gynecology oncologist and found that my margins for AIS were not clear, meaning abnormal cells remained in my body after the LEEP. I proceeded with two additional attempts at conservative approaches to preserve fertility with laser conization.

This avoided a hysterectomy, and after three procedures, my AIS margins were finally found to be clear. However, I knew there was a chance we didn’t get it all (due to risk of skip lesions) and that AIS could be progressing as I went about my daily life.

Two years after my diagnosis and after several failed fertility treatments, I decided that I couldn’t live with the fear of invasive cancer any longer and I proceeded with a hysterectomy. I made this decision knowing that I would never carry my own children.  But making this choice may very well have saved my life.  

I decided to trade my fertility for my life. Or that’s how I saw it. I suppose I consider myself “lucky” for my brush having not been worse, but it doesn’t feel so lucky when you are going through multiple repeat procedures and recoveries.

But I wouldn’t have had these choices had I found this later.

Thus, this is a cautionary tale for physicians and physician trainees. Give yourself the same consideration you give your patients. Keep up to date on your preventive care. Make the appointment for your annual well exam. Schedule your screening mammogram. Get that colonoscopy on the books. And follow up on your results.

As we approach the new year with hope and good intentions, let’s start a regimen of looking out for our health. This includes important, everyday practices such as getting proper rest, taking mental breaks, going for walks, and eating healthful foods.

Your best chance to continue to provide excellent care for your patients is to provide excellent care to yourself.

Special thanks to Dr. Angela Holdeman for reviewing the gynecology medical descriptions of this process.