Thank you for an introduction. So I'll start with my disclosures. I must confess that I'm not a mental or physical health specialist. However, I'm a South American interventional cardiologist that graduated in Brazil and practice in Canada with a restricted license. I am a mid-career interventional cardiologist. I have four kids, two of them teenagers, and I do CTOs. So yeah, I can talk a little bit about mental and physical health. So on the mental health side, should we be worried about it? So depending on how you define mental health conditions, you may have a prevalence of 27 to 90% of cardiologists having mental health conditions. You see on the graph on the right that 83% of the cardiologists that describe some sort of a colloquial depression, which is a pretty high number. But who suffers from these mental health conditions? There's not much news here, everyone would expect, unfortunately. So women, 31%, South and Central American, and Hispanic, by the way, South and Central American and Hispanic, they are not the same. This is a misconception. And it's 45%, mid-career, 39%. And what are the characteristics independently associated with this? So this other study was just published in JAG this year, showed that those that would develop mental health conditions would have had emotional harassment, discrimination, be a South American, be early or mid-career, and divorced. And it's not only about the doctor. We're just the tip of the iceberg. You see that the cardiologists, 50% of the cardiologists are conflicted as parents. Burnout had a negative effect on their personal relationship, and 62%. And even our patients are being affected by the depression that's been happening. And what causes these mental health issues? Well, again, unfortunately, no surprises. Too many bureaucratic tasks, lack of respect, lack of autonomy, electronic health records, and so on and so forth. This other paper showed that adverse work environment was more common in stressed and burnout physicians. Is this an association or is it a causation? What we do know is that what was expected to help us actually creates more problem. We know that one hour of direct patient care equals a two-hour of EMR, plus one or two extra hours of personal time each night to finish a job that should have been done during the day, and you just didn't have the time. And a hostile work environment was unfortunately very present, and it starts early in our career. There is this very nice piece written by Dr. Khadum Al-Aswad for TCTMD describing his early phase, his early career when he had some abuse, and it's heartbreaking to read it. So there's this cycle of the mental health condition, how it happens, and usually there's a trauma that precedes the mental health condition. And for multiple reasons, shame, fear, stigmatization, negative impact on the career, we tend not to do anything. So we actually start this defense approach where we start using alcohol, drugs, and this leads to more trauma, such as isolation, divorce, and the cycle just propagates. The fact is we all have been fostering a culture of silent suffering, and people don't seek for help. They create these barriers to avoid being stigmatized, shame, embarrassment, dishonor. How do we break it? How do we end it? Well, first, we need to break the silence, de-stigmatize the mental health conditions, and still install mitigators, such as mentoring, DEI promotion, harassment policy, and so on and so forth. Other ways are selective promotion of leaders who strive to mitigate implicit bias, discrimination, harassment, while advancing diversity, equity, and inclusion, and also ensuring that physicians not only report their condition, but they have the time to receive the necessary treatment. And what have we actually been doing? So based on this survey, we're not doing much of this. To alleviate burnout, we reduce work hours. We do some stress reduction techniques. We change some of our workflow, but that doesn't really help. How do we maintain our happiness? Staying with family, doing exercise. And it's interesting that we are even willing to take a cut in our paychecks so we can have a better work-life balance. What about physical health? Well, we do need to be worried about physical health. You can see in this paper published in 2016 in CSERC, cardiovascular interventions, that the longer you are working with radiation, the more likely you are to have issues, skin lesions, orthopedic illness, cataract, cancer. And it's not only about physicians. Non-physicians are affected the most. Nurse, techs, we all are affected by physical conditions. Our society has published this document trying to address some of these concerns along with other societies. And this is a very busy slide where they, and I'm sorry for this, but it basically describes the best practice and future directions. I'm going to highlight a couple, not a couple, but a few. So on the best practices, it's encouraging the development and an early adoption of new technology. If you think that the lead apron that we use in the cat lab nowadays is pretty much the same that Gruzing was using, it's crazy. Can't we get something that is as protective as the ones that should be? I mean, we have the tungsten, the lightweight, but they are not as protective in terms of radiation. Can't we get anything better? And when talking about future directions, having hospitals upgrade equipment as fast as possible to reduce radiation, having hospitals providing the lead apron and protective eyeglasses. It's interesting. My institution doesn't give this. We all have to buy it. And another interesting point, other protective equipment should, such as disposable radiation chilled beds, should not be refused by hospitals due to their expense. It's always about money, right? So in conclusion, physical and mental health conditions are common, maybe very common, in the catalyzation laboratory. And as Dr. Caper was saying, the more awareness, the better. And solutions that are written must be offered. And I'd like to finish with this piece from Andrew Sauer, who wrote an editorial on that publication. And I'm going to read this. And although we know we need to better attend to our multiplicity of needs, we find ourselves immersed in dedication to our patients while subservient to a hierarchical system without compunction of exploiting our ethos while also conditioning us to treat to our lonely workspace and think I'm crazy rather than this is crazy. Thank you very much for your kind attention.

prevalence of mental health conditions

cardiologists

depression

factors contributing to mental health issues

physical health concerns