Colonel Robert Oh, MD, MPH, CAQSM is a board-certified family medicine physician with an added qualification in sports medicine. He has led residency programs and served deployments in Kosovo and Iraq, spending 18 months in hostile fire zones. With his expertise on health and fitness, he was selected for the Army’s Surgeon General’s Performance Triad and System for Health Directorate as the Physician Lead. He currently is the Chief Medical Officer at Martin Army Community Hospital, Fort Benning Georgia.
One of the key principles of leadership is leading by example. In my early years as a physician, my goal was trying to be the best, most competent physician that I could be. Increasingly, I realized that I could only influence patients one at a time, and I also realized in the arena of health promotion, prevention and self-behavior change, it was not simply a matter of knowledge. Most people know what to do to influence and improve their health. Influencing health and changes in lifestyle is deeply personal and frankly, especially in the areas where self-care is the critical component for health, most do not appreciate a lecture on one’s shortcomings.
In my years as a physician in the military, I’ve learned that true leadership is not necessarily telling people what to do. Leading by example can truly help demonstrate the elusive, difficult to teach, principles of the Army values – leadership, duty, respect, honor, selfless service, integrity and personal courage. Simply put, more is “caught” than “taught.”
This same principle applies to creating healthy teams, a priority for many of us in America, and certainly a priority for the military. I truly believe that teams that are healthier – not just in physical activity, nutrition and sleep, but emotionally and spiritually while remaining balanced in their work, life and family/social connections – will not only have better physical health, but perform better at work.
One of many defining moments in my career came during my deployment to Kirkuk, Iraq. Physicians and clinicians often struggle to take care of their own health because of the hours they spend caring for the health of others. The burnout among physicians is becoming an epidemic, as nearly 50 percent of physicians report burnout in their profession. Physician suicide is also a significantly under-recognized problem in the US. In a 2015 study by the Journal of the American Medical Association, nearly a third of doctors in training are depressed or exhibit symptoms of depression.
The benefits of working out can’t be understated – and not all of them are physical. Cognitive performance clearly improves after a bout of vigorous exercise. The social community effect is also under recognized and likely protects against depression. According to a study by the American Psychological Association, “…active people are less depressed than inactive people. And people who were active and stopped tend to be more depressed than those who maintain or initiate an exercise program." Many cancers can even potentially be prevented with exercise – breast and colon are a few with studies supporting exercise.
But just telling my team and telling people to exercise doesn’t easily change behaviors. Instead of telling, I often try to invite. In deployment, I got hooked onto CrossFit. But, it wasn’t because someone told me to do it, it was because someone invited me to try it and we journeyed together into a new fitness program. I was tired of the traditional bench press Monday, legs Wednesdays and Back Fridays with 3-4 times a week running. I needed something else to motivate me. From the first day, I was hooked. Then I continued to work out with others, and during my next deployment to Iraq, I started doing physical training with CrossFit with all the medics on my team, together. It’s one thing to tell medics to stay in shape, it’s another to see their battalion surgeon do the same workout together (and lifting more than some of them!).
Optimizing human performance has always been priority for the military. The military views Soldiers as professional soldier-athletes. The stronger our Soldiers are, the better they are equipped to perform at their peak. If we optimize their cognitive, physical and emotional arenas, the more they will be able to face chaotic, unpredictable circumstances. To ensure our soldiers are at their best, we focus on sleep, activity and nutrition but also emphasize holistic health – including emotional health, spiritual health, balance in work/personal life and connection in the community. We are not there yet, but we will continue to focus on the holistic health and fitness of the Total Army.
These same principles apply to those of us who practice medicine. Whether we are in direct combat, we frequently work long hours (a resident physician works an average of 80 hours per week), sometimes under intense pressure (an emergency room in the middle of the night), with lives depending on us. The importance of holistic health to optimize a physician’s performance cannot be overstated.
The Performance Triad, and its focus on sleep, activity and nutrition works together to optimize a physician or clinician’s performance. These healthier behaviors can help improve decision making, reaction times and self-regulation during times of intense stress and urgent and emergent situations. I strongly feel that the more we take care of ourselves, we can better take care of the patients that entrust their care to us. I feel it is absolutely critical to optimize these behaviors. Not only does it help the physician, but it will automatically overflow into natural conversations with our patients to influence their health.
How do we start? By starting with us, looking within and the teammates we serve on the front lines.
Disclaimer: “The views expressed are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.”