The Holidays: The Good, the Bad, and the Ugly
Check out the good, the bad, and the ugly side of the holiday season and how it impacts the overall well-being of both physicians and patients.
Unfortunately, because the holidays are a time when many people ignore their health, we also know it is harder to get them in the office for a visit. Of course sometimes it can wait (ie, a routine check-up), but other times patients are risking their life by putting off an office visit, like after being discharged from the hospital.
A population-based, retrospective cohort study found higher readmissions and death after discharge during the holidays; one major contributing factor they established was lack of follow-up (most of us intuitively know that). Based on these results, for every 100 000 people discharged during the holidays there were:
- 2999 fewer follow-up visits within 14 days
- 483 excess ED visits
- 188 excess hospital admissions
- 26 excess deaths
What type of appointment is popular around the holidays though? Botox injections! It’s important to look good for those pictures with Santa.
“Easy on that eggnog, Aunt Jane!” While the red wine “in moderation” debate rages on, what is clear is that too much alcohol increases the risk for cancers of the gastrointestinal tract, liver, and breast as well as high blood pressure, obesity, stroke, and sudden cardiac death.
In acknowledgement of these risks, numerous societies including the American Cancer Society and the American Heart Association have issued statements urging people to limit alcohol to 1-2 drinks/day for men and 1 drink/day for women.
One widely-read 2018 meta-analysis in The Lancet analyzed 694 data sources and 592 prospective and retrospective studies and concluded that no level of alcohol consumption is safe and that alcohol is the 7th leading cause of death globally.
While the study methodology was criticized and the results said to be overstated by some, what was clear was a dose-dependent relationship between alcohol and health problems, beginning at about 1 drink/day (the 95% UI on ‘non-drinkers’ was 0-0.8).
Heavy alcohol consumption may be a holiday response to stress-this is the time of the year benzodiazepines are being refilled, by the way (I had one patient admit it: “I need it – my family is coming over!”). It seems like everyone is stressed out with getting the house ready for guests, buying presents, decorating, etc. All that stress can really add up.
While the effects of chronic stress on the body are widely known, perhaps a lesser known phenomenon is the true health effect of holiday stress. Many of us have probably intuitively known it for years, but did you know there is actually literature to support the notion?
Numerous studies have established an association between the holidays and an increase in cardiovascular (CV) events (termed the “Christmas Holiday Effect”), including heart failure exacerbations, cardiac mortality, and acute myocardial infarction.
Everyone needs time to recharge the batteries, and while it can be harder as a clinician to get time off, it’s important to take care of yourself so you can take care of your patients. Just as more stress from the holidays can increase CV events, time off from work can help prevent those events, so it’s a shame that Americans took an average of just 10 days of vacation in 2018.
One study followed 12 338 men with coronary heart disease over a 9-year period and looked at all-cause mortality, death due to CV causes, and death due to non-CV causes. The most striking results came in the death due to CV causes group: more annual vacations were associated with a 29% relative risk reduction, and the authors still found an association after adjusting for several potential confounding factors.
Another interesting study followed men for 40 years and found that men in the intervention group (who were given lifestyle counseling, intensive medical follow-up, and prompt initiation of blood pressure and cholesterol treatment) had a 37% greater chance of dying if they took ≤3 weeks of vacation/year.
Family relationships have a profound influence on our overall well-being and strong family connections can help keep us healthy. Several large studies, including one published in Science and one of the longest-running studies on happiness conducted by Harvard researchers, have tied social connection and relationships to reductions in overall mortality and thus to longevity.
One meta-analysis that looked at >308 000 people, found the impact of social relationships on risk of death was as strong as that of well-known risk factors for mortality. A 20-year study even linked a strained relationship with parents, siblings, or extended family members as being potentially more harmful to health vs a strained relationship with a spouse.
So forgive and forget, and enjoy that time with your see-once-a-year side of the family!
Want more holiday content from Patient Care® Online? Check out 10 Doctor Gifts Worth Giving (and, having) and 8 Tips for a Healthy Holiday Season for healthcare-related gift ideas and tips for a safer, healthier holiday season.
Stay in touch with Patient Care® Online:
→Subscribe to ourNewsletter →Like us on Facebook →Follow us on Twitter →Follow us on LinkedIn
The holidays tend to be a time of emotional ups and downs for many people. Family time can bring both stress and joy, the coziness of cold weather and a fireplace inside brings people together but also makes them inactive, and people everywhere are running from place-to-place trying to prepare. For most people, the last thing on their mind is staying healthy; after all, that’s for New Year’s Resolutions, right?Ignoring your health, even just for a short period during the holidays every year, can really take a toll. Let’s look at the good, the bad, and the ugly of this holiday season. And remember â just because you are a doctor doesn’t mean you don’t need a doctor!