June 2018
Dr John Best
ACSEP Fellow

Last month I was taken aback by the open and courageous article written by Dr Kate Harding, following the suicide death of her husband Dr Richard Harding.1 Kate, Richard and their children had moved from the UK to New Zealand where Richard had worked at Whangarie Hospital. He was an Anaesthetist and Intensive Care Physician. Kate is a GP and Palliative Care doctor. Richard had suffered deteriorating mental health following a patient complaint from the GMC, made 22 months earlier, whilst working in the UK. 

This sad story has led me to offer my thoughts on how we can encourage each other to better health and to identify our own challenges before they get out of hand.

Being connected with the ACSEP has given many of us the opportunity and privilege to give talks which promote health. We do it every day in our clinical practice. Over the last decade I have become increasingly passionate in encouraging men to pursue healthy living and to improve their well-being. A more recent event was as a speaker at a golf luncheon. This was a group of around eighty men. Average age 60, many semi-retired, wealthy and overall most would be considered ‘successful’ in life – depending on your definition of course. Their usual type of speaker for this event is a comedian, sports identity or some public figure. That said, I was surprised to be invited to speak for 7 minutes on “men’s health”, take some questions and MC an open microphone session.

It's always good to crystallize your thoughts by preparing a short presentation. What will be my main take-home message? What statistics will they remember? – that barely 20% of Australian men have regular GP (for women it’s close to 80%)2; that the suicide rate in their age group is almost five times that of women3 or that the Centre of Disease Control in the USA lists “loneliness” as the major health risk for men due to its impact on the person as a whole4

This event led me to create a very simple tool for health promotion, which I apply to myself (and is gender neutral). It is the metaphor of a ship, “The S.S.MAN” which takes you on your journey through life. Whether it’s a rough stormy period or a period of smooth sailing, I explained to these men that the S.S.MAN can be strengthened and relied on.

S.S.MAN is an acronym which I feel covers five components of good health. Let me run through it:
S – Sleep. Essential and irreplaceable. Good sleep is gold. Bad sleep is very unhealthy.
S – Spirit. More and more research identifies that our spirituality is a big part of our well-being: 
the things that give us purpose and meaning. We all have it. It can be more than one thing.
M – Medical health. Physical and mental health. Everyone needs a good GP. Doctors need great GPs.
A – Activity levels. The benefit of physical activity speaks for itself.
N - Nutrition. This includes alcohol and drugs.

I spoke briefly to each point and had some anecdotes and funnies. I encouraged the men to use their periods of “smooth sailing” to reinforce the S.S.MAN, to look at areas for improvement in these five components. For those times when you are in a storm and life seems out of control, get help, do some self analysis and make the changes that are needed.

There seemed to be engagement as they listened. The Q&A was fine, and then many men, one after the other, came up to the open microphone and openly talked about various health problems and challenges they had suffered. Cancer, depression, relationship breakdown, unemployment and on and on it went. To my gratitude three semi-retired doctors were in the audience who also came up to reaffirm my message - in particular the need to have a great GP.

When I offered to write this piece I received some input from colleagues who had read the article by Dr Kate Harding. I will abbreviate these comments:
“….the equating of “busy” with success”……. leads us to compare with superficial measures, looks past the true value of being a compassionate doctor, implies that you need to pack a lot in to your life , sacrifice other valued aspects, in order to be truly useful”.
“You can be so “busy” (read successful) that you run yourself ragged, become prone to mental and physical illness, neglect family and community etc etc. Or you can tell your colleagues you are “so busy” and then feel like a fraud - like you don’t stack up”. 

“…our aim should be to be the best person we can be and not look at performance”

“..we need to be vigilant in our care for ourselves and relentless in looking out for others”

There were some comments about the changes in medicine and the challenge of being caring in the current culture and business environment.

Dr Richard Harvey must have been very unwell at the time of his suicide. His spirit must have been crushed. His family have been through a nightmare.

When I think of my own health and test it against the S.S.MAN immediately I can identify two areas which need improving – sleep quality and also the nurturing of some of my important friendships (which have been getting crowded out). Both affect my spirit.

Let me encourage you to take a few moments, do some self analysis and see if there is something that you need to address. In the very least I would urge you to ensure that you have a great GP. If you need help now contact your GP, a colleague or lifeline (Australia 13 1114; New Zealand 0800 543 354). You will not be a burden.

And finally, let's look out for each other. Consider reaching out to a colleague, give them some time and ask them how they are.

Dr John P Best
Sports and Exercise Physician, FACSEP

1 https://www.doctorportal.com.au/mjainsight/2018/18/doctors-wellbeing-learning-from-richards-death/?email=bestfam@bigpond.net.au&lid=915514&utm_source=MJA+InSight&utm_campaign=36e8479f57-EMAIL_CAMPAIGN_2018_05_11&utm_medium=email&utm_term=0_7346f35e23-36e8479f57-42101189   
2 www.vichealth.vic.gov.au/
3 www.abs.gov.au
4 taken from ‘Suicide, Loneliness and the Vulnerability of Men (Dr Ken Eisold, 2013)