stress

see also:

• psychiatry and mental health
• psychology
• prevent burnout, learn to reduce your stress and stressors
• fatigue
• fear
• Coping with shift work
• sleep hygiene
• insomnia
• anxiety
• regret and regret avoidance and decision making
• clinical burnout
• post-traumatic stress syndrome (PTSD)
• YOUR hospital's policies and procedures to assist with your stress or crisis management
• The Guardian 2015: working from home including checking work emails increases stress and impacts health
• Employees use humour to reduce workplace stressors efficiently
• viewing images of nature changes brain responses to painful stimuli and reduces pain (go camping!) ¹⁾

• Vic. Govt - personal support fact sheets - stress after emergencies, traumatic experiences, family crises
• Vic. Govt - managing stress after emergencies - Bali bombings response (pdf)
• RACGP document - keeping the doctor alive
• are you a doctor or medical student and need to see a doctor confidentially?
  • see Vic Doctors Health Program
• Anxiety Disorders Assoc. of Vic. (AdaVic): ph: 03-9853-8089
• burnout - symptoms and management

• the term “stress” was popularised in 1950's by Hans Selye, an Austrian-born Canadian physician. Prior to this the usual phrase used was “under strain”.
• in engineering terms, strain is a measure of the extent to which a body is deformed when it is subjected to stress, while stress is the force exerted on a body that tends to cause it to deform.
• in response to Selye, psychologists developed tables of what were asserted to be highly stressful events, such as death of a spouse, being sacked from a job, moving house, getting a divorce, etc.
• everyone experiences stress, but of itself it does not cause emotional distress:
  • athletes inflict force upon themselves in order to change their form - they voluntarily subject themselves to stress with enthusiasm & commitment, in the expectation of improving performances - they call it training.
  • an environmental stress may generate emotional distress or it could be used as the challenge that strengthens us.
  • nevertheless, like athletes who over-train, excessive stress for our level of coping will tend to result in exhaustion, conflict, frustration, anxiety & depression.
  • extreme emotionally stressful events may lead to delayed post-traumatic stress syndrome in susceptible people.
  • how doctors manage stress is often dependent on their personality²⁾

• Cognitive rigidity
• Difficulty with ambiguity
• Problems with setting boundaries
• Inability to forgive oneself or blaming others
• Irritability or sarcasm
• Feeling of emotionally exhausted
• A sense of depersonalisation (cynical and detached)
• Muscle tension/headaches

• emotionally stressful patient situations (eg. death of a child)
• pressure to work beyond your abilities
• lack of support from senior staff or inpatient units
• insufficient time to further develop your abilities
• pressure to work when not physically well
• lack of adequate staffing to cover sick leave
• generalised job dissatisfaction & distress
• lack of the expected rewards of appreciation and approval from peers, management and patients
• imbalance between work, family life and fun
  • checking work emails when off duty increases stress and impairs sleep
• inability to cope with work levels or poor patient care levels:
  • exit block - this is soul destroying as, regardless of clinical skill, you are unable to practice medicine to your own standards
  • persistent excessive patient workloads resulting in excessive waiting times & patient dissatisfaction
  • poor inpatient support - delay in having patients reviewed or admitted
  • inadequate facilities to deal with patient load or conditions
  • presence of poorly performing peers
  • inadequate change management
  • perception of inadequate support or abilities of management ED or hospital
• anxieties related to:
  • ability to perform - risk of making judgement errors or procedural complications
  • risk of needlestick injury or exposure to other illnesses such as TB
  • risk of exam failure for those sitting exams
  • acceptance by peers
• professional nihilism
  • for example the negative views on the current medical profession and the commodification of doctors - see here
• existential crisis:
  • wikipedia
  • gifted children (ie. doctors) and lifelong tendency to spontaneous and reactive existential crises

• having a current medicolegal matter
• not taking a holiday in the previous year
• working long hours
• type of specialty
• having personality traits of neuroticism and introversion.
• see ³⁾

• male
• being Australian-trained
• being between 40 and 49 years of age
• having personality traits of neuroticism and extroversion
• failing to meet Continuing Medical Education requirements
• being a solo practitioner
• see ⁴⁾

• Towards longevity in emergency medicine. Chris Curry. Emergency Medicine (2002) 14, 102-5.
• eMJA 2004 - Burnout and psychiatric morbidity in new medical graduates