PHILADELPHIA -- The country has reached an important tipping point, and it's important for physicians to speak about moral issues that affect their patients, former Surgeon General Vivek Murthy, MD, MBA, said here at the (ACP).
"We have an opportunity to speak up for the vulnerable and voiceless ... People will accuse us of being political, but if people accuse you of being political because you're standing up for people who can't stand up for themselves, then you should do it anyway, because that is at the heart of our profession," Murthy said Thursday at the meeting's opening ceremony, to loud applause. "If we do that, we can can shift the balance on the single most important struggle I believe is taking place in society right now -- the struggle between love and fear."
"There is so much fear in our country, manifesting as anxiety, jealously, rage, and insecurity," he continued. "We see it in conversations around the dinner table. But there is also a lot of love in our country, which manifests as kindness, generosity, compassion, and joy. In the struggle between love and fear, which way is the balance going to tip? Will we allow our country to be governed by fear or will we stand up and allow our nation to be governed by love?"
Murthy also spoke about one issue he focused on as Surgeon General: the nation's epidemic of loneliness. "If you had told me ... 5 years ago we would be talking about the subject of loneliness, I would have looked at you funny," Murthy said during an interview with Darilyn Moyer, MD, ACP's executive vice president and CEO. "But this is an issue I really came to be educated on during my time as Surgeon General by the people I met in communities all across America."
He explained that when he went on a "listening tour" in the beginning of his tenure in the office, "people told me stories about addiction, about their struggles with mental illness, issues about obesity, heart disease, and diabetes in their family, but what they often didn't say -- but what became very clear in their stories -- were also these threads of loneliness and disconnection that many people were experiencing. They didn't lead with them, but their stories were undoubtedly often about them."
The study data on loneliness isn't as good as the data on diseases like diabetes and hypertension, but looking at some of the initial data, even with the lower numbers, it still pegs loneliness rates among adults in the U.S. at around 20% -- "and that's people who actually admit on surveys they're struggling with loneliness, so the real number is likely higher," said Murthy. Other studies have found that loneliness is associated with a markedly higher risk of heart disease -- around 30% higher -- and that the risk of dementia, depression, and anxiety also goes up. "Even lifespan seems significantly shorter for people who are lonely."
"Of course there's a causal question here; is loneliness driving these outcomes or are these outcomes accompanied by loneliness?" he added. "But either way you look at it, it's hard to escape the idea that social connection is a healing force we need to cultivate, and that we have, in fact, in many ways neglected or taken for granted."
The loneliness issue is relevant to physicians in several ways, Murthy said. First, "whether we know it or not, many of the patients we're caring for are struggling with loneliness. I took care of many people who were lonely, but I never knew it because I never asked about it -- I didn't know how to ask about it, and I didn't know what to do with the answer if I got a 'yes.'"
But despite the difficulties doctors may have in broaching the subject of loneliness with patients, "Loneliness is relevant to our profession because it affects our patients and ultimately impacts their willingness and ability to engage in plans of care we develop," he continued. "And there's one last reason it's important to us: it affects us [too] ... It's just as common among physicians compared to the general population."
Like other people, "we [as doctors] need to be connected and feel a sense of community in order to sustain our energy, our motivation, and really the quality of the work that we do ... We have to focus on how we rebuild a sense of community."
One community-building exercise Murthy and his co-workers employed during his time as Surgeon General was the "Inside Scoop."
"We said, 'We'll take 5 minutes once a week and during the 'all hands' meeting, give that 5 minutes to one person in the group and ask them to show the group pictures of anything they want, as long as it's not related to their current job,'" he said. "People, through those simple 5 minutes, gained an understanding and felt a sense of connection to each other that was more profound than what we had seen develop in the prior year."
For physicians who might be struggling with burnout, Murthy said two of his professors in medical school taught him the importance of gratitude for renewing energy and changing one's emotional state. And although doctors "don't have an hour to meditate in the middle of the day and think about all the things we're grateful for ... what [my professors] taught me is that we don't need an hour; sometimes all we need is 5 seconds," Murthy said.
One of his professors, a couple of seconds before he entered a patient room, "would pause, take a deep breath ... and remember who he wanted to be when he walked in." Another, while washing her hands, "would take an extra 5 seconds ... and let the water run over her hands, and during that time remember what she was grateful for that day," Murthy recalled.
"That's a small technique that I've found to be quite helpful."