Managing StressBy Flora Johnson SkellyThis article was originally published in American Medical News, the weekly newspaper of the American Medical Association. It is republished here by permission of the author, Flora Johnson Skelly. According to medical educator Timothy P. Brigham, PhD, stress is "the basic confusion created when one's mind overrides the body's desire to choke the living daylights out of some jerk who desperately deserves it." A more conventional definition is that stress is what happens when perceived threats chronically activate the body's "fight or flight" response. However it's defined, stress is an important health concern for today's physicians, agreed
experts attending the third International Conference on Physician Health, sponsored by the
American Medical Association, Canadian Medical Association., Federation of State Medical
Boards, and Federation of Medical Licensing Authorities of Canada. The meeting, titled "Stress:
The Profession, the Family and You," was held in Ottawa, Canada in 1994. Some of the topics
were:
Here's some other information on managing stress This material was originally published in the Oct. 24/31 and Nov. 7, 1994, issues of American Medical News, the weekly newspaper of the American Medical Association. They are published here by permission of the author, Flora Johnson Skelly. Recognizing symptoms of stressThe very characteristics society values in physicians, because they make better doctors, also make doctors unusually susceptible to the negative effects of stress, experts said.Most physicians are "compulsive," said psychiatrist Roy W. Menninger, MD, chairman of the trustees of the Menninger Foundation in Topeka, Kansas. This is manifested in traits such as attention to detail, hyperconscientiousness, deep commitment to the patient, and the ability to absorb and contain anger and other negative feelings. Physicians also tend to be "perfectionistic," "workaholic," and "markedly guilt prone." In other words, "the average MD doesn't get much fun out of life." Furthermore, physicians tend to be so self-sacrificing that they feel "guilty about any attention to their own needs." As a result, they are "usually the last to admit" that they are suffering from stress. Symptoms may include physical reactions such as cardiovascular, gastrointestinal, and respiratory problems. But stress also can manifest itself in other ways, which are "often more obvious to others" than to doctors themselves, Dr. Menninger said. People under stress often exaggerate normal behaviors -- for example, working even longer hours. They tend to "become a caricature of themselves: Quiet people become quieter, loners become more isolated." Other behavioral changes may include sleep disturbances, withdrawal from colleagues and friends, decreased work effectiveness (for example, unaccustomed difficulty managing patients or fear of referring patients), or increased drug and alcohol use. Emotional reactions can include anxiety (tension, nervousness, jumpiness, inability to relax), hostility (irascibility, anger at minor things), "scapegoating" (blaming others, fault finding, being critical or hard to please), and depression. Markedly increased family tensions also are common. These include the appearance of stress symptoms in other family members, fewer stress-free conversations, fights "about everything and nothing," few shared satisfactions, and a tendency by both spouses to easily become upset or angry. Frequently, said Dr. Menninger, any or all of the above symptoms are accompanied by denial by the physician, that anything is the matter. For Dr. Menninger's thoughts on how physicians can take better care of themselves, see Beyond Jogging. Return to summary at the top of the page Healthy relationships as stress bufferAnother theme sounded by experts attending this conference was that strong intimate relationships can serve as an important buffer against negative effects of stress.Walton E. Byrd, MD, clinical director of Springbrook Northwest, an addictions treatment center in Newberg, Ore., said the quality of physicians' relationships affects not only their likelihood of becoming chemically addicted but also their chances of a successful recovery. Unfortunately, behaviors such as compulsivity and perfectionism tend to undermine intimate relationships, said Dr. Byrd. A particular problem for physician relationships is what Dr. Menninger and his colleague Glen O. Gabbard, MD, have dubbed the "psychology of postponement," Dr. Byrd said. Beginning in medical school, physicians put their time and effort into medicine while important relationships are neglected. By the time physicians do find time for their marriages, their spouses are angry and resentful; both parties are "lonely and isolated" and may have developed chemical addictions. Physicians with troubled relationships often benefit from professional help, Dr. Byrd said. Springbrook Northwest is offering couples therapy as part of its approach to treating recovering physicians, using a model pioneered by the Menninger Clinic in its annual "Physician Marriages" workshop. (The Menninger Clinic's "Physician Marriages" workshops are held each July in Colorado. For more information, call Jane Roberts at (913) 273-7500, ext. 5994, or (800) 288-7377. Fax, (913) 273- 9941.) Dr. Byrd encouraged physicians with troubled marriages to participate in programs such as Menninger's. He also urged all physicians to give time to their important relationships. "You need to set aside time each day to talk about yourselves. You need to block out time once a week to go out dinner or go to a movie. You probably should try to grab three or four weekends a year together somewhere." Return to summary at the top of this page A new way to thinkAll people are not equally stressed by the same environment, said Dr. Brigham, assistant dean for continuing and graduate education at Jefferson Medical College in Philadelphia, in a workshop on resident stress. The difference often lies in how each person thinks about a potentially stressful experience."Stress is a reaction to a perceived threat. What you're telling yourself about what's happening may be what makes it seem to be a threat." Individuals tend to develop habitual ways of reacting, said Dr. Brigham, and certain habits increase vulnerability:
Fortunately, these habits are "not ingrained personality patterns" and thus can be changed, said Dr. Brigham. Although it's easier to change these patterns with expert help, anyone can learn to challenge them:
Return to summary at the top of this page. Stress-reducing techniquesEdward Messner, MD, associate clinical professor of psychiatry at Harvard Medical School in Boston, summarized the contents of his book, Resilience Enhancement for the Resident Physician (Essential Medical Information Systems, Inc., 1993). These approaches are just as useful for practicing physicians as for residents, he said. Dr. Messner emphasized that people should choose techniques that best suit the situation and themselves. Strategies include:
Many people also find they can manage stress through physical activity, said Dr. Messner. Activities such as stretching, isometrics, or running up and down stairs can be as effective as jogging. It's even possible to release pent up emotions through such techniques as pounding a pillow or mattress or screaming into a pillow. "This can release a great deal of tension without alarming the neighbors." Relaxation techniquesfor lessening feelings of stress and counting stress-induced insomnia
Return to summary at the top of this page Asking for helpPhysicians who cannot manage stress on their own should not be afraid to seek professional help, the experts said.Vancouver, B.C., psychiatrist Michael F. Myers, MD, called upon all physicians to fight the stigma traditionally attached to psychiatric illness and examine their own feelings with regard to peers who seek psychiatric help. Physicians who have had counseling or psychiatric treatment, and are willing to discuss it openly, should consider writing or speaking about it, he said. "We must do what we can to help colleagues who are ill." Dr. Myers, whose half-time private practice is almost entirely made up of physician patients, urged professionals who treat physicians to pay particular attention to protecting their patients' confidentiality. However, the stigma attached to seeking care is being overcome, said Dr. Myers. "More and more physicians are `coming out' about having been treated." In all, said M. Roy Schwarz, MD, AMA group vice president for scientific, educational, and practice standards, the "take-home" message from this conference was a straightforward one: "Recognize the stress. Admit it's there. There are accepted ways to reduce your reaction to stress. But if you can't handle stress, don't hesitate to ask for help." Return to summary at the top of this page. Beyond JoggingWhen psychiatrist Roy W. Menninger, MD, chairman of the trustees of the Menninger Foundation in Topeka, Kans., recommends physician self-care, he goes beyond the usual recommendations of exercise and a healthful diet. In his keynote address at the International Conference on Physician Health, Dr. Menninger urged physicians to:
Return to summary at the top of this page. Coping With Being SuedProfessional liability litigation typically lasts 25 to 27 months, 40 to 46 months if the case actually goes to trial, said Theodore L. Passineau of the PICOM Insurance Company in a workshop at the International Conference on Physician Health. Here are some of Mr. Passineau's suggestions for coping at such a time:
Return to summary at the top of this page. Copyright © Flora Johnson Skelly, 1994
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