“Dr. Cheng, I feel dizzy.”

We’ll call him Joe. I miss Joe. I met him in his early 60s, a pleasant, dapper, rotund man with a jovial demeanor and well-groomed mustache. He was always on time to his appointments and came with crisp reports on his subjective state of health. Whenever I saw Joe on my clinic schedule, I knew at least that part of my day would be good.

Joe lived a conscientious lifestyle. He paid attention to food and movement, and cultivated relationships that held him up in life. When I think of Joe, I remember feeling unworried about his habits and longevity. So it bugged me that his blood pressure was never well controlled. On maximum doses of four medications, it was consistently 140/90 (ideal is 120/80 or less), and it just would not come down. Luckily for me, his previous doctor had done all of the appropriate work up, including sleep study, kidney imaging, stress testing, etc. Eventually they decided together that this was as good as it would get, and Joe would just focus on doing the healthiest things he could every day and get on with life. I concurred.

So when I got the call months later that he was dizzy, my heart sank. We agreed he would come in that day and we’d figure out next steps. I was prepared to call the emergency department and my cardiology friends to let them know I was sending him over for a cardiac event. But on arrival he didn’t look ill or unwell, just moved a little more slowly. His mood was great, though, maybe even better than usual. I asked him why, what had changed? “I retired!”

His blood pressure was 90/60. He was still taking all four of his blood pressure medications, like the diligent patient that he was.

Back then, in a typical primary care practice seeing a patient every 15 minutes, I did not consistently ask deep questions about people’s work stress and meaning, like I do now. Turns out, Joe had a lot of mental stress at work. He managed it well, though–never lashed out at people, never let it affect his performance. Colleagues threw him a big party and he retired feeling satisfied, looking forward to his next life chapter. And it wasn’t until later that he realized how much his work had cost him in health. Over the next several days, we learned that he only needed a low dose of one medication to keep his blood pressure in the 110/70s. The dizziness went away. I think he was getting ready to go on a cruise. I left the practice soon thereafter, and I don’t know about Joe now. I hope he’s still happy and well.

I remember this story so clearly because until recently, it stood out as unique–that my patient could correlate such a dramatic improvement in a crucial vital sign and a leading risk factor for heart disease to retiring from a stressful job.

Not so unique anymore, though. This year, no fewer than four of my patients have experienced the same thing, but in the opposite direction. Having never had high blood pressure before, they all called me with new symptoms: headache, fatigue, full body tension, and just feeling off. Before calling, they thought to monitor their blood pressure, and all of them reported consistent home readings well above 150/90. And they all knew exactly when it started, all correlated with severe work stress escalation. Adjuvant factors included increased travel, longer work hours on global calls, less time for exercise, and continued business eating. It’s all a downward spiral, for sure, and I submit that the underlying cause, the change that makes four people present suddenly in these six months, is our post-pandemic work environment. While I welcome the increased flexibility and autonomy of a hybrid office model, I’m not sure the net effect is good for us long term. Work-life boundaries have perforated, if they even still exist at all. Given the volume of articles in business periodicals progressing from ‘quiet quitting’ to overt labor force decimation, it’s quite clear to me that we have not invented a kinder, more effective work culture. More and more I hear and feel an ‘us versus them’ gulf growing between workers and leaders–yet another relationship domain affected by polarization. It’s as if the short term, profit driven, make money at any cost prepandemic ethos, suppressed and reassessed (I thought?) during three years of acute obligatory disruption, became an abscess that has now ruptured and resurged–exploding like ‘pus under pressure,’ as we say. Organizations scramble to restore anteCOVID earning and productivity status, still measuring success and achievement with the same metrics as before nature showed us how vulnerable we and all of our systems are. We have learned nothing.

All of these patients are now taking at least one blood pressure medication, pulling hard on their stress management skills, and maybe reassessing whether staying in their current roles is worth the cost to their health and relationships. We connect regularly and I always ask, how much longer can you keep this up? How will you know when enough is enough? What will you do then? I don’t recommend that people quit their jobs–that is not my place. But I ask the important questions, lovingly and bluntly.

What does it cost us indeed, as a society, to be killing our workers this way? When will we recognize that sacrificing people in the short term actually wrecks collective success in the long term? When will our culture value people over profit? I hold leaders accountable for their relational output at work, and I also recognize that they–as we all–are simultaneously agents and victims of our complex adaptive systems. Culture does not change easily.

If I have any hand in it, however, more of us will move closer to challenging and changing the most toxic aspects of business culture, one organization, one team, one person, one interaction at a time.