As per the title - I'll try and give my personal and professional experience, without providing any specific medical advice (which is fraught with risk over the internet, without being familiar with your medical history).
I have been working as a specialist General Practitioner for the last 5 years, and am currently working in a COVID screening clinic in Melbourne seeing all the lovely coughs and colds.
Not being critical or anything - many doctors say they hardly get any education on lifestyle medicine in medical school. Start with Code Blue documentary.
Are you conflicted in genuinely applying this (vs throwaway comment), because it would effectively change or do yourself out of your current job (and potentially not providing sufficient return on your investment/time studying/qualifying) of diagnosing and treating?
You're assuming that MD's become so due to financial motives rather than the motive to actually help people be healthy and live longer. I'm sure there are some that went into the profession due to the financial gain, but I'm sure there are others that have a more altruistic reason.
If you've read the OP's other responses, you'll see they are more the latter type so it is a bit insulting you've asked this imo
I'm not implying that (re financial gain). Do you know much about lifestyle medicine? It provides the context to what I'm asking. Have a quick squiz of Code Blue doco and others and you'll see where I'm coming from.
There isn't much curriculum in med school regarding the 'specifics' of lifestyle medicine (can't speak for GP training). Most doctors would be able to quote guidelines for recommended daily exercise and general nutrition, but I would haphazard a guess that doctors with more detailed knowledge in these areas would have developed a special interest in exercise physiology and nutrition (i.e. actively seek out and read new literature).
Re: does promoting lifestyle medicine put us out of a job? No, there will always be enough people who don't adhere to lifestyle changes to sustain the medical industry
able to quote guidelines for recommended daily exercise and general nutrition
Agree. This is just effort vs outcome orientation. Just parroting some guideline doesn't shift to a prevention focus. Basically they have to live it. Just like seeing an financial planner/coach - do they live in the Eastern Suburbs, Mosman, etc. or Mt Druitt?
Do you still find any part of your job "gross" or "icky" or does nothing worry you at all any more after youve been a GP for a bit and seen/done it all?
read back on first page, is detailed quite well
did you ever watch Becker growing up and was he/what is - your motivation to becoming a doctor?
No I didn't, I hadn't heard of it before. I had two potential career interests after high school - either becoming a biomedical engineer, or a pastor (I know, very different fields) - but I guess having Asian parents with high expectations they wanted the more traditional and aspirational career pathways with stable income and they encouraged me to go into law or medicine.
Funnily enough, being in medicine (and more specifically in General Practice) allows me to blend my interest in science while caring for people at the same time, so in a way, it worked itself out
If your patients had knowledge in Med/ Physciology, would you rather they let you know upfront or just shut up entirely?
Whatever they feel comfortable disclosing - but I find if I do have that awareness I'm able to pitch the language and steer the conversation in a way that makes sense to them. I've had doctors as patients as well.
Funnily though I don't volunteer this kind of information when I consult other doctors for my own issues, because I don't want to be treated any differently (though I don't hide it either).
If a very healthy patient came in and asked to be prescribed Metformin, even though they don't have diabetes, because they read this book and the studies on pubmed which show it's anti-aging benefits, what would you do?
I'm not aware of its use for anti-ageing so would probably need to look into it before I prescribe it, however it's not entirely out of the equation as I know it's also prescribed for other non-diabetes indications like PCOS
Doctors can only prescribe medicines based on their conventional therapeutics. If lets say you were given metformin for some 'anti aging' reason and you died from lactic acidosis, well, then the prescribing doctor would likely be destroyed by the coroner.
We use things off label frequently. However it may only be covered by the PBS for a specific use. You'd only be destroyed by the coroner if you had no scientific basis for doing so.
commonly used off label is one thing, such as quetiapine used to help with borderline BP or amitriptyline with IBS. The grey area may be a bit different with low dose naltrexone with fibromyalgia. However, metformin for 'anti aging' will be hard sell to peers if the patient develops severe side effects. I always tell my reg's that if something is used for off label, it has to meet specific criteria 1. is there GOOD evidence, 2. are the risks of side effects low, 3. is the condition something specific, 4. do you have specialist documentation and 5. are you trained or have a good understanding of the treatment.
@eldudebrothers: What is the definition of off label?
If something like the therapeutic guidelines lists a drug, its better evidence than the manufacturer provides, but it still might not be in the PI
@greatlamp: Off label is off the TGA approved indications in this country. Off PBS is if something has a PBS restriction (like terbinafine).
what are your thoughts on immunology for allergies and do you have any successful cases?
Are you referring to immunotherapy? If so there are plenty of people on it for refractory allergic conditions and who get lots of benefit out of it, the main disadvantage being the potential cost and also the need for injections (with subcutaneous immunotherapy). More information here…
yes sorry, I meant immunotherapy. I was wondering if I'm wasting my time.
I've only just started and have 5 years to go.
As my allergies have wrecked my sleep for a decade.
I have more confidence now to stick with it - thank you for your reply.
You're NOT wasting your time!!
I live in dustbowl central (Canberra).
Started my monthly injections about 18 months ago.
YOUR LIFE WILL CHANGE… DO IT NOW!!!
I couldn't sleep, I couldn't function during the day, I'd be so noddy I'd micro sleep even during a 15min drive.
Nose would run like a tap.
I tried all over the counter stuff, then prescription stuff, and nothing worked.
Nothing except immunotherapy. It's a life changer, and I can't tell you how strongly I recommend you get on it ASAP.
I now only pop a Fexo180 on the rarest of days, and that's only because I feel the nose tingle or have a chain of sneezes… and then unbelievably the Fexo will sort it out on its own. Maybe once a month if that? I used to pop them (and other meds) DAILY.
Go do it mate, you won't regret it.
When does your license expire, and are you getting the vaccination.
Our AHPRA registration expires on the 30th of September every year and needs annual renewal, if that's what you mean?
Personally I'm going to hold off on the COVID vaccination until I get more information on potential risks and side effects. Mind you I'm not anti-vax, I have the whole suite of childhood immunisations and annual flu shot, just that I want to know what I take is safe and backed by evidence. You can see my earlier replies for more around this topic.
Sorry in advance for the questions but I'm genuinely curious.
Actually the main question I had which I'd forgotten and only came back…
The general public should be extremely concerned about the lack of the increase in Medicare bulk billing rebates because as I've mentioned earlier, it's simply not possible to continue providing good quality care in General Practice, and GPs are forced to limit the length/complexity of their consultations in order to remain financially viable. Bulk billing doesn't equate to free care as ultimately taxpayers fund Medicare, and Medicare expenditures have continued soaring despite MBS rebates for GPs not keeping up in line with increases in the CPI. I strongly disagree that it's greedy to expect higher remuneration for honest work provided, given we pay other professions their due in recognition of their training and service provided (and rightly so). Why should General Practice be any different, particularly when it comes to something as fundamental to human survival and wellbeing as our physical health?
In a previous post I alluded to the the qualities of good General Practice being affordability, accessibility and quality. It's pure idealism to expect that General Practice remains accessible and/or of high standards when the government is not investing into it.
I'll just add on - nursing homes don't supplement your income, they are a drain on it. You earn much more sitting in your clinic than leaving the front door for home visits and nursing homes. The government have gutted rebates for these and often these patients can least pay.
Why do doctors whether in public or private medical settings insist that all specialists in the same field have the same level of skill and expertise when clearly in reality there are good doctors and bad doctors with varying levels of competence?
I mean there's always a class idiot at med school or someone who barely made it by the skin of their teeth. This kind of variance is natural and expected, they can't all be the same.
Not sure which doctors out there are insisting that all specialists have the same skill/expertise as you and I both know that clearly isn't the case. I know of some shocking GPs that I wouldn't send my worst enemy to. Sure we have to practice at minimum acceptable/safe standards, however people aren't just happy to settle with 'good enough' and deserve the best possible care.
I find this variance selects out in specialties though. The people who made it by the skin of their teeth were probably just extremely bored by the subject matter but go on the be amazing surgeons because they like working with their hands. Does it matter if they can't remember the Krebs cycles or the clotting cascade? Not really, I want my surgeon to make good anastamoses, not read books.
Just like all cardiologists aren't the same. Some are brilliant at titrating medications in hard to treat arrhythmias and hypertension who I wouldn't want otting a cannula in my while others can do central lines and acing wires no problem.
If a GP is saying "here's 3 options, they're basically the same, chose one" it's because to them, these 3 options are similar. They have already cut out the terrible options and the rude ones who never answer their phone for advise or send letters back. So to them, the 3 are the same. This may be a completely different opinion of others who work with them. (if you want to know which surgeon to use, find a scrub nurse who works with them)
Not being snarky, but then you have this:
https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-…
I'd like to think Australia does better but we have our own Dr Death.
Making an error does not make someone a bad doctor, it makes them human.
Yes, errors can cause death. Which is why there are so many checks and balances that happen in hospital. However if all the people in the line of checks and balances have their one error on the same day, things still go wrong.
The vast majority of errors are not due to incompetence or maliciousness. They are simple slips in concentration that usually are picked up by colleagues. When they are not, doctors are horrified and usually have a rebound change of practice (i,e, overinvestigating or overadmitting pts with that conditions for a while) which can lead to it's own morbidity and mortality.
Would you trust the average doctor to not try an cover up a mistake if they thought they could get away with it, even if or especially if it were a very serious mistake?
There's a reason why doctors have been consistently rated among the most trustworthy professionals in polls over the years. That's not to say that there aren't individual doctors that try to cover up gross negligence or malpractice, however with so much regulation in medical practice these days it's very difficult to deliberately cover these up.
I've made minor mistakes in the past (e.g. administering the wrong vaccine), however I documented these and contacted the patients straight away to apologize and fix the situation. I find this transparency only helps to foster trust and deflects anger in emotionally fraught situations.
This may end up overlapping with the bulk billing question before, but what is your view on people putting off going to see a GP because of the costs? (… this is OzBargain after all)
Dunno about others but I've been burnt too many times where I'd go to a clinic, wait for ages, have the doctor seemingly milk to "just go over 15 minutes" (or whatever the billing block was), and fork out lots of dollars for not much info. And with lots of bulk billing places saying seniors or some other special conditions only, the options are limited.
Since I've already used it, I'll stick with the analogy of cars - sure, you can save money in the short term by putting off servicing your car, but in the long term things will inevitably start wearing out and you might find yourself stranded in the middle of nowhere with costly repairs.
Ignoring your own health is a false economy, because it comes back to bite you when you least expect it. You may believe you'll be able to function at your existing level indefinitely, and you may not even notice any symptoms, but underlying conditions like high blood pressure, cholesterol and smoking (among many others) all cause cumulative risk for disease over time. As GPs, we have an understanding of the longitudinal risk over the human lifespan and can advise on the most appropriate preventative actions that need to be undertaken.
Does talking to a G.P about mental health or stress, etc, affect one’s ability to get health insurance/life insurance?
Yes. As soon as that is documented in the medical record, it labels you.
I have been to a counsellor twice, once when I was young and my grandmother died and then again when I went to discuss techniques to avoid burnout (very common with my work). I did not feel like I had mental health issues at either time. Never been diagnosed with e MH condition nor taken medications.
I have a mental health exclusion on my life insurance.
Not that this should stop you from seeking help when required.
What is your opinion on Chiropractors? Also, why do they call themselves doctors and use the Dr. title when their level of studies only requires a Masters degree to be qualified?
im also a GP and there are some who perform a lot of principals of physiotherapy and osteopathy. These guy are alright. The ones that deal with BS with the mantra of "all disease is in the spine" are insane. a Dr title is meaningless. I have seen dog myotherapists with a Dr in their name
I've seen a vertebral artery dissection and a stroke post neck manipulation. I would never recommend it to friends or family. Stick to physios.
What is that? eli5 plz
The vertebral arteries (along with the carotids) are some of the main arteries supplying blood to the brain, and due to their course through the vertebrae, any sort of physical trauma to these arteries (especially neck manipulation) has the potential to cause tear to the lining of these arteries which can lead to a stroke. It's one of the well publicised potential complications from neck manipulation and could occur even with the most assiduous due diligence and experience.
I think it's these kind of unproven and risky procedures which give chiropractors a bad name, and subsequently I leave them a wide berth.
In relation to your question about the "Dr." title - I believe this has been discussed at length in the previous page
For a profession that seemingly requires a high level of tertiary education and general intelligence, why are all bulk billing GP's, and by all, I actually mean all of them, so incredibly shit and unimpressive at their jobs? Is the perception of just how hard and arduous it is to become fully qualified, overstated? Are foreign qualifications more like first aid certificate levels of equivalence? I got so turned off by the whole system that I only end up at a Dr when I'm dying and I need the referral to someone who knows whatever specialist area requires treatment. I feel like this is a pretty common reason for why males refuse to seek healthcare for things.
I see GP as the bottom of the medical profession totem pole. I'm not sure what their income level is but I hope it is worth going through years of university for the job?
Purely because of time. I spend minimum 20mins per patient and can do that because I charge for it. If you value your health, $30 isnt much. You can be the best doctor in the world but can do jack all in 6 minutes. Complex problems can take over 40mins and there have been times where I have spent over an hour for patients in mental distress. Being a doctor who 1. cares 2. spends time 3. fixes problems instead of just turfing to ED other specialists, 4. communicates and teaches well, 5. continues to study, 6. has special interests and 7. is nice, is definitely common in the private/mixed billing world. I am sure those bulk billing clinics will change to become like the above if the government increased the patients medicare rebate but I dont see this happened unless every doctor decided to private
Yeah I see time being the excuse for bulk billing doctors being horrible but that's a copout. If you're good at your job, actually have interest in the field you work in and have an iota of compassion or empathy, you're already going to be better than all of these useless (profanity). 1 minute, 7 minute, 3 hours. None of these times prevent you from exhibiting these attributes. Some medical problems can be complex and that requires time, resources and effort. That's up to the doctor to communicate and escalate to the relevant specialist or book multiple appointments. You can't just go "Lol 7 minutes is up, soz can't help you bro. Could be cancer but just take some panadol"
Also has anyone ever seen a poor GP before? Nah, didn't think so.
hello eldudebrothers, are you in NSW? I would travel (and pay) to see a GP like you. I and my friends and loved ones have sadly found it really hard to find a GP with all the qualities you mention and have no idea how to find one without reliance on trial and error. Will PM. Hope its ok.
The main way to find one is to look for a private billing GP. If you aren’t getting the service you pay for, see another.
To the poster above, it is about time- the doctors who bulk bill just train themselves to be extremely superficial and not take detailed histories etc. empathy does take time, so does rapport. Many don’t even examine.
@cynicor: Not all bulk-billing doctors practice 6-minute medicine, and seeing a privately billing doctor doesn't necessarily guarantee that they will be empathetic, spend extra time or practice in a thorough manner. I think it's a bit unfair to tar everyone with the same brush.
My recommendation is to get recommendations from people you know, and you will get an idea when the same names consistently crop up in conversation.
@inasero: Thank you @inasero and @cynicor. I will try to ask the people I know but most seem to go to their local bulk billing place I guess on an "as needs basis" eg for the cold and flu, i.e. in a reactive way. And many dont see the same GP over the course of time because they see one thats close to their work etc and only once every few years…
If any ozbargainers dont mind sending their Sydney GP recommendations via PM, would appreciate that.
I am advancing in my middle ages and want to find a GP who will help me be more pro-active rather than re-active in looking after my health, which I think will benefit not only myself, but my family, workplace, community and health system (preventative health measures I believe are far less costlier than treatment). Theres some family history issues which I think would be good to look into together with a GP to ensure prevention/ early detection.
Thanks for reading and for your thoughts.
@inasero: While that is true that "not all" it's pretty much the rule and those that don't are exceptions.
His profile says Melbourne
Hello harn.mui, I don't work in NSW but I would check out reviews on google/facebook and see what people have said about the clinic/doctor. But thank you.
@eldudebrothers: Personally I think review od GPs on google are near useless. Most people will only jump on there to complain, and it's usually about something nonsense. Personal recommendations are often best, or trying to find who a doctor sees- if you know anyone who knows a doctor!
@inasero: Probably not. I do not think patients are very good at determining quality care. Doctors who over order tests can be seen as "thorough". Doctors who are easy to get into as they see patients every 6 min are "available and quick". It's near impossible for patients to determine gold standard care, which makes it hard for them.
Same here. I recently visited a bulk billing GP who did not offer/refused to inspect my problem physically. I described the acute pain and lump which I was experiencing in the bottom region and the guy just took my word for it - didnt bother to inspect. I described what i thought it was based on symptoms i googled and for the next 15 mins the guy was basically looking up keywords on his computer or telling me useless shit I had already read through google. Finally had enough and insisted on showing him photos instead after which he fobbed me off with some generic antibiotics and painkiller cream. Kept saying 'go to ED if very painful…i cant do anything here'. Needless to say I never went back and went to another GP for a second opinion. Oh yea to top it off the guy charged level c consult which I believe is a higher charge for longer consultations. Pretty sure we were under 15 mins.
Not a question but I loved reading these answers and just from your responses I can sort of feel you are a good GP.
When I was young, just moved out of home I found getting sick and various things hard to deal with and for whatever reason, financial or otherwise I really didn't want to go to the doctors. I am not sure if this just applies to me but I would imagine perhaps a fair few young people have similar feelings and reflecting on school etc I don't think bulk billing, referrals etc were ever discussed.
WA has an awesome program called Dr YES which is run by med students. They do sessions on sex ed or alcohol and drugs and also mention at every session that teens can get their own medicare card so things are private.
That sounds like a great initiative, I remember avoiding it simply because I thought it would be very expensive and reading reviews for most clinics were often negative.
Nowadays I just visit whenever something is up, usually 2-3 times a year, had an STD test and am comfortable around any GP.
Thanks for your kind words :)
Yes I agree that navigating the health system can be oftentimes confusing (even for adults), and there should be a mandatory health curriculum of sorts in school, with education on how to access medical care e.g. GPs, Direct Line, Beyond Blue, Butterfly Foundation, sexual health clinics, Headspace…
My GP charges Medicare 2 minutes repeat scrips Level B, and most of 10 minutes consultation Level C. Is this normal?
Do you consider to offer discounted consultation fees for Ozbargainers? Cheers.
If by level b and c you mean item 23 and 36 respectively, then this is completely illegal.
That's difficult to know and not for me to judge, without knowing your personal circumstances and what was actually discussed during the consultation. Sometimes our perception of the time spent in a consultation can vary from the actual time spent. Also is the consultation literally "just a script", or are their other health issues also discussed?
If it was purely in and out for a quick prescription, then yes, it does seem unusual to bill a level B consult for this.
Yes it's just a script. Nothing else. It's less than 1 minute and bulk billed level B to Medicare.
When we attend pregnancy related specialist appointments, I noticed when I accompany my wife to the doctor's suite, the doctor also bulk bill specialist attendance to my Medicare as well.
have you already self-misdiagnosed yourself with something?
Not that I'm aware of, fortunately, because I'm still relatively young and blessed with good health. But it is recommended for doctors to have their own doctors to look after them, and not self-diagnose. In reality it happens all the time though (the self-treating, not the misdiagnosing)
What's your take on medicinal cannabis. Legalize it already? Do doctors really get some sort of incentive to prescribe deadly/addictive pain killers, instead of cannabis which can be grown in someone's own backyard almost for free?
I’m not OP but there’s a lot here. Legalisation is complex and mostly around addiction and mental health issues. Cannabis/THC is not a safe drug like you seem to imply.
No doctor gets incentives to prescribe opiates but thc is addictive in its own right, and causes serious morbidity too. To think there is a conspiracy around who is making money is ludicrous- the cannabis companies are mostly owned by Pharma anyway.
And finally, remember you can easily grow your own poppies for free too, so there no difference at the end of the day.
the people i know who have tried it for cancer related ailments unanimously say that
- it doesnt help with appetite
- it makes them too sleepy during the day (but does help with sleep at night)
- does not help with pain whatsoever
I believe there is a recent journal in pharmacology confirming this.
As far as anxiety and relaxing it kind of got a "meh"
Its hardly the miracle its announced to be, but judging from the adjectives used you kind of have a bias in favour of cannabis (besides being able to grow it is a whole different problem to being used or not as a medical treatment, and i believe it would discriminate against a whole lot of people who need it more than those able to garden/having a garden).
i have no opinion on it other than what decent studies say, i dont like the myths and flat earther attitude that goes with a lot of people arguing in favour of it.
GP's are hot property amongst certain ethnic groups. Do you get a lot of overly friendly patients who care more about you than their medical condition?
Nope cos I'm there to do my job and get them better, not to talk about my achievements
Say you work at a bulk billing clinic as a contractor, do you guys only get 65-75% of the Medicare bulk bill rate?
Bulk bill or non bulk bill, the lowest service fee from a practice is around 30% and the highest around 40%. Very occasionally a practice might charge only 25%, mainly when starting up.
Yep this ^
How reliable ar GP in assessing moles for skin cancer risk? Is it better to go straight to a dermatologist or where can i go to do a proper skin check?
Alot of GPs will be able to do dermatoscopy (and some even do whole body photography) for skin cancer however the quality really varies and my recommendation is you really have to go to someone who has an established interest in this area, because at the end of the day its all about pattern recognition. They don't necessarily have to be a "skin cancer doctor" or dermatologist, as many GPs have a special interest in this area and have more experience than many dermatologists in this field (as well as charging far less fees). Ask whether they have any additional qualifications in this field like the UQ Certificate in Primary Care Skin Cancer Medicine, and if not, they'll know of at least a few GPs in the area with a special interest in this field who you can be referred on to.
Thanks for the advice.
My parents used to have a GP where they brought the whole family to see including us kids for vaccinations etc.
Now I am all grown up, I would like to access my old medical files and get a comprehensive view of what vaccines I have had during childhood, school years etc. Is there a central register where all these things are recorded, in case the GP no longer has my files?
When I change GPs, should I ask for a copy of my medical records? Is the point of the Governments myHealth record to keep a copy online so that anyone who needs to (including the patient themself) can access the full medical history?
Yes and no. There are registers of somethings, like vaccinations for kids. That recently got funding approved for expansion so it now covers all vaccines for all ages, but it won't really catch up, so it's going to be great for kids born now, less so anyone else. Similarly, you can ask the clinic for a transfer of records, but myhealth record is not really meant ot be a surrogate for that. it's about your overall health status and major changes, not for each consultation record.
You might have luck at getting your school vaccination records by contacting local council. I believe it is where I got proof of mine when I needed them.
You can also try contacting the AIR (Australian Immunisation Register) which should have a copy of your immunisations, however your records may not be necessarily be on the system if you had them some time ago before the National Immunisation Program came into effect.
When changing GPs, you can request a copy of your records be forwarded on to your new practice, and generally it's a good idea to have all your records together. Whether you choose to keep them online (on My Health Record) is up to you, but it's not foolproof and I have security concerns about it so persoanlly I choose to keep mine at one practice.
Do GP's really earn so little money that you need to service your own car? I knew it was tough with the Medicare freeze but that's just a bit depressing.
Haha I have my own mechanic (a top bloke too), but I like cars and understanding how things work! Thank you for your concern though, I'm doing just fine :)
I don't think OzBargain should be allowing medical advice from a random person on the internet.
What's the best treatment for genital herpes?
What was your favourite subject in high school?
In high school, did you get higher marks in English or Mathematics?
Did you do 4 Unit Mathematics in high school?
You didn't get answered so…
In my day, it was most common to do 2maths, 2 science and 2 humanities. Because English and English lit couldn't be used to make a TEE score.
I don't think you could do 4 different maths subjects at once.
Chemistry was a prerequisite. Physics was a semi prerequisite (if you didn't do it in school, you had to do an extra subject first year uni)
Thanks for your time!
Which subject did you like more in high school, English or Mathematics?
What is your favourite flavour of ice-cream?
Haha good question! I'm partial to cookies and cream myself - though the ones with large chewy chunks in them, and not the ones with fine particles like sand
Yourself?
I know gelati and ice-cream are two different things but I really cannot go past a lemon flavoured gelati, very refreshing on those hot summer days.
Not sure I 100% understood what you were asking, but I'll try to answer the best I can. Before these COVID lockdowns I used to go to the gym everyday after work listing heavy compound weights (or doing light cardio on my off days) for around 1 hour. It helped that the gym was literally next door to the practice so I didn't find it a drain on my time at all. Obviously that's gone out the window now with the lockdown restrictions in Melbourne (and I'm still personally hesitant to go back even though gyms are opening back up again), and I definitely could stand to lose a couple of kilos from the effects of boredom eating.
In fact, I genuinely believe and advise my patients that exercising is the best investment in their time because it forces them to organise their schedule better, improves mood/sleep, improves mental clarity throughout the day, improves capacity for physical exertion (which helps in activities of daily living) and of course maintains cardiovascular health (the main cause of morbidity and mortality in our Western society).
Having that energy, mental clarity and positive outlook on life can only help with productivity at work, and I would strongly encourage investing your time in daily exercise if that's something you're hesitant about.