The US Dept. of Transportation recently changed their requirements for healthcare providers to take a course and pass a test in order to be able to do physicals for these important workers who keep our society and industry rolling.

As a rule, doctors complain about this sort of thing.  More regulations, more finger-pointing.  And the truckers and other drivers, like those who drive trains or busses, are also beseiged by regulations.

The DOT is strict about blood pressure, sleep apnea, vision, hearing, diabetes, seizures and other issues, and reasonably so, because DOT drivers have a 30% higher risk than the general population of having health problems.

WHY?

This is 5 pillar stuff–all of it.

1. Pillar # 1:  Drivers are often on the road for a long time.  They are away from their families, many have financial concerns and are the breadwinners.  Many rely on their driving for their livelihood and the potential for disability is devastating.
2. Pillar #2:  They often don’t sleep enough or don’t sleep well, as they are on the road a long time and may smoke to keep awake or pass the time.
3. Pillar #3:  They drink everything except water, often also to keep awake or pass the time, and they don’t like to make pit stops.
4. Pillar #4:  Rest and relaxation may be a couple of beers or a glass of whiskey before bed–see Pillar # 2.  The hours and places are not conducive to regular schedules and workouts.
5. Pillar #5:  The highways and byways are littered with fast food, full of salt, fat, sugar, caffeine, nicotine, hot greasy and tasty stuff that is quickly satisfying, but a quick ticket on the heart-disease train.

I am a certified DOT medical examiner.  I am always sad when I have to disqualify someone, and I have frank discussions about the rules, about the things they can do to get their certification back, and I always tell them that FIRST I am a physician, which means that my first duty is to the patient, and that I am committed to giving them good advice and guidance, because I got into this profession because I care about people and their health.  And everybody and everything else comes after that, whether it is the company I work for or the DOT.

I have sent people to get treated for their sleep apnea, their heart arrythmia, their terrible blood pressure, and their vision before they can get their certificate.  It is hardest when people are older and heading for retirement, struck by something that holds them back from being able to work.  But you know, my patients understand this.

I sit down and have a frank discussion and I tell them that the most important thing is their good health, and the reason they need to go get things checked is not just because the DOT says so, but because I would be a bad physician if I did not pay attention to the things that could really hurt them, not to mention the other folks on the road.  I don’t want my patients to drop over from a sudden heart-attack or a stroke that might have been prevented.  I don’t want them miss a road sign and get hurt because their vision wasn’t good.  I want them to get to retirement!  And you know, for all their toughness (and they are tough men and women by all means), they are good about it.  They understand, even though they don’t want to, and they will make the haul for themselves when all is said and done.

But you know, we often focus on the folks with the problems.

• INSERT RANT:  Things seem dire, and we as physicians don’t even look you in the eye while muttering the usual “diet-and-exercise,” from between clenched teeth, which is, I must say, the most trite and meaningless thing that doctors and other health professionals tell people whom they secretly (or not so secretly) disdain.  I think it is the worst possible thing that any doctor or medical professional can say to anybody.  I think it should be stricken from medical-speak.  It is the pinnacle of doctor and patient condescension and reflects the hopelessness in our medical system.  Truthfully, 95% of “diet and exercise” fails.  Don’t believe me?  Go check the statistics.  Not good odds for advice or a prescription.  Why wish that on anybody?  EXIT RANT.

So I try to spend some time focusing on the DOT drivers who come through with healthy blood pressure, weight, and few if any health issues.  Many have quit smoking.  These folks have beat the odds, and they are doing something that other people may not be doing.

So I say to them (and for that matter to any patients whom I see who are very healthy in any context), “I am really impressed that you have managed to quit smoking!  How did you do it?”  Or, “You beat the odds, your blood pressure is great!  How do you keep so healthy?”  And I will clarify, “the reason I am asking is so that I can help other drivers and other patients who are struggling.”

And this is where I learn some really great stuff.  I am a listener.  I am a networker.  I am happiest when I can draw a picture, connect the dots, and be a bridge for others.  This makes for a very positive patient encounter.  And patients are glad to oblige.

• Driver #1:  My blood pressure is good because I never go to bed angry.  I don’t let things get to me.  My family and my faith are important to me and help to guide me.  It is not worth being angry because all that does is hurt me.  I have a good sense of humor.
• Driver #2:  Now that Subway is at so many of the gas stations, like Loves, I find that it isn’t so hard to eat there instead of eating burgers and fries.  It helps.  My whole family is diabetic, but I am not.
• Driver #3:  I’ve become a pescatarian.  I was scared about becoming diabetic and I had gained a lot of weight, so I lost it by switching to this diet.
• Driver #4:  You know I have made my health a priority.  I TRY to eat well.  I don’t always do it, but I try to think about good choices and make them.  I make some time to exercise.  I go for a walk with my dog.  Again I try to follow a schedule and I don’t always do it, but I try.  I know my family depends on me, so I try to be as healthy as I can.
• Driver #5:  I quit smoking cold turkey.  I just decided to do it.

Doctor’s note:  This is the one that surprises me the most.  Most of the folks I know who have remained smoke free for a long time have quit cold turkey.  I think it is the hardest way to do it because of the side-effects–crabbiness, anxiety, mood swings, but it seems to work.  These folks don’t pick up another cigarette again.

• Driver #6:  I had a gastric sleeve procedure and lost 150 lbs.  I watch what I eat now.
• Patient (over 100 years old):  The secret to a long life?  I like to kid around.  I eat all sorts of things, everything–vegetables, meat, bread, and I love the ladies.  I just got married to a younger woman.  She is in her 80’s.  I keep active as much as I can.
• Couple married over 50 years:  The secret to a good long marriage?  Humor.  Never go to bed angry.  Be able to laugh at yourself.

I don’t forget these folks.  They stay in my mind and in my heart, and when I see someone struggling, I reach into my Mary Poppins carpet bag, and I pull out these words of advice.

You know, it makes for a very satisfying and interesting patient encounter when one actually has a conversation with the patient!

I know my my encounter is done to my satisfaction, when my patient leaves smiling, even though things may not have worked out the way they planned.

The best of health,

Doc Bea