This month, the literature and medicine group at my hospital met to discuss Arthur Miller's Death of a Salesman. The play, which first opened in 1949 with Lee J. Cobb in the leading role (clip here) and is now playing in Boston at the Lyric Stage Company, concerns Willy Loman, a man in his sixties who hauls a sample case up and down New England with "a shoeshine and a smile." Charm is important in sales and Willy has plenty. He is, as he says repeatedly, "well liked." He is also miserable. His marriage, his relationship with his sons, and his mental health all teeter on collapse.
As health professionals, it was hard for us to talk about Willy Loman without wondering what we would do if he were our patient. For one thing, we agreed, we'd tell him to switch jobs.
A 2005 article in the British Medical Journal confirmed what most of us know intuitively: your job has a strong effect on your health. The BMJ was not referring to the physical danger workers in some fields face (logging, fishing, piloting and roofing topped a recent list) or the poor health care coverage many workers have--especially those who work part time jobs--or to environmental exposures like dust, asbestos, and "sick building syndrome" or work-related symptoms like carpal tunnel syndrome from typing.
No, the occupational health risk to which the article referred was job dissatisfaction. People who don't enjoy or feel fulfilled by their work are more likely to be anxious and depressed and, to a lesser degree, more likely to have physical symptoms. I've seen patients with headaches, nausea, dizziness, tremors, and back pain which disappear on the weekend (unless they happen to work on the weekend). In one dramatic case, a patient who hated her job began vomiting every Sunday night and threw up repeatedly until Friday.
I find that when I ask people about the causes of work stress and dissatisfaction they tell me one of three things: 1) They wish they were doing something else (staying home to raise kids and not staying home to raise kids are frequent examples) 2) Their work load is simply too heavy (layoffs and consolidations in recent years have made this more common; 3) They work with a toxic colleague or boss. #3, in my experience, is the most stressful.
Economic realities are such that not everyone who dislikes their job can quit, even if they suspect the job is making them sick. But it still may be helpful to recognize the link between job dissatisfaction and health. I've had patients, motivated by health concerns, who work with therapists, employee assistance programs, and HR departments to improve their work experiences. The Mayo Clinic, recognizing the importance of job satisfaction to heath, offers tips on its website.
Meanwhile, don't hesitate to talk to your doctor about work. And don't be surprised if we ask if you like your job. We're not just making conversation.
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