The Top 4 Things That Keep Doctors Up at Night

Doctors might seem pretty unflappable under stress, but they are people, too, and they have hidden fears and things that keep them up at night, just like the rest of us. Except those fears are often influenced by what they see in day-to-day medical practice ... which is a lot.

So what gives a neurosurgeon nightmares? What makes a dietitian’s stomach churn? We asked doctors and medical experts from across medical specialties about what haunts them — here are their answers and what those answers mean for you and your health.

The risk of antibiotic-resistant bacteria  

There are lots of creepy bugs in the medical world, like deadly fungi and misfolding proteins called prions that can spread in food and linger in water and soil. But one of the scariest? Antibiotic-resistant bacteria.  

“What wakes me up at night? Concern that antibiotic-resistant microorganisms continue to threaten the health of our patients,” says Paul Pottinger, MD, an infectious diseases physician at UW Medicine. “I worry that we doctors overprescribe antibiotics, and that our colleagues in the pharmaceutical industry are not incentivized to create enough new antimicrobials to keep up with the evolution of drug-resistant germs.”  

His concern is justified: There are more than 2.8 million cases of antimicrobial-resistant infections each year in the U.S. alone, according to data from the Centers for Disease Control and Prevention (CDC). This includes bacteria as well as fungi, viruses and parasites.  

Globally, millions of people die each year from antimicrobial-resistant infections, and the World Health Organization (WHO) lists antimicrobial resistance as a major public health threat.   

“We all hold part of the solution: physicians and patients should use antibiotics wisely, industry should be motivated to make new medications, and our elected officials in the federal government should intensify their interest and legislative activities on this important public health crisis,” Pottinger says.

One concrete way you can help stop the spread of antibiotic-resistant bacteria? When you’re prescribed antibiotics, ask your doctor if it’s the shortest course you can take. Research has shown that shorter courses of antibiotics can be just as effective as longer ones.   

The burden of colorectal cancer

We have the tools to prevent many cases of colorectal cancer or detect them early. But instead, it remains one of the most common causes of cancer death in the U.S. In fact, it’s now the leading cause of cancer death among people under 50.

“We have become extraordinarily good at treating the downstream consequences of colorectal cancer,” says Christopher Damman, MD, a gastroenterologist at UW Medical Center – Montlake. “But we remain far less effective at addressing the upstream forces that shape risk: a food environment engineered around convenience, palatability and profit; loss of dietary quality and microbial diversity; and enormous disparities in people’s ability to access, understand and act on good health information.”

What’s more, colorectal cancer disproportionately affects some people who are already more vulnerable or face disparities in other areas of life, including people with lower incomes and people in rural areas.

“I think medicine has to become better at connecting biology with the environments in which people actually live,” Damman says. “That means moving beyond simply telling people what they should do and building tools, food systems and health systems that make healthier choices understandable, accessible and achievable.”

To stay on top of your health, be physically active, eat a healthy diet and get colorectal cancer screening and any other tests your doctor recommends. For most adults at average risk, colorectal cancer screening begins at age 45. 

A preventable (and sometimes deadly) brain injury

You might have noticed a resident neighborhood gaggle of middle school or high school kids on e-bikes or e-scooters, or maybe even those e-motorcycles that are becoming more popular.  

While these rides may be fun for kids, they’re also dangerous — especially if they aren’t wearing helmets.  

“The single problem currently keeping me awake (literally and figuratively) is pervasive brain injury associated with e-scooters,” says Ali Ravanpay, MD, PhD, a neurosurgeon at Harborview Medical Center.  

He and his colleague Robert Bonow, MD, also a neurosurgeon at Harborview, have seen and treated a huge increase in traumatic brain injury (TBI) patients at Harborview this past year due to e-bike and e-scooter accidents.  

“Any bike without a helmet is scary, but e-bikes are particularly terrifying,” Bonow says. “We’ve seen lots of head injury cases, and some have resulted in death.”  

According to a statement issued by the American College of Surgeons, e-bike injuries tend to be more severe than injuries while riding regular bikes, and head injury is more common. Most e-bike riders don’t wear helmets, and e-bike injuries are increasing annually in the U.S.

So if a young person in your life rides an e-bike or e-scooter, encourage them to wear a helmet. It could end up saving their life.  

An overlooked but vital nutrient

For Judy Simon, MS, RDN, a dietitian at UW Medical Center – Roosevelt, the biggest problem she sees with her patients is that they aren’t eating enough fiber.  

“People are so focused on protein that they’re forgetting about fiber,” she says. “Most folks are nowhere near the target daily fiber intake, which is recommended at 25 to 35 grams of fiber daily.”  

This may seem like a small issue, but a lack of fiber in your diet can contribute to gut issues and make you less healthy overall. Plus, fiber has a multitude of health benefits, such as regulating blood sugar and insulin responses, supporting healthy cholesterol levels and reducing inflammation.  

Overall, research has shown that higher fiber intake is associated with reduced all-cause mortality, says Simon.

Reaping the health benefits of fiber is relatively simple: Try to eat more produce, whole grains and other healthy foods high in fiber. You can start by “dripping” more fiber slowly into your regular diet (and if you want to try fibermaxxing, you might want to first learn if it’s actually a good idea).

But don’t let all this keep you up

There you have it; now you know what keeps some doctors and medical professionals up at night, and how you can apply that knowledge to improve your own health.  

But one thing to keep in mind: Try not to let obsessing over being healthy keep you up at night. Yes, it’s important to do all the things your doctor tells you to do in order to stay healthy, like exercising, eating nutritious foods, connecting with loved ones and taking care of your mental health. But it’s OK to be imperfect in those endeavors; the important thing is that you make an effort.