Health and Wellbeing: Stress
“Stress is a condition or feeling experienced when a person perceives that their demands exceed the personal and social resources the individual is able to mobilize”. In short, it’s what we feel when we think we have lost control of events. The key concept here, is that it is an emotional and physical response to a thought process, and that other factors influence how we respond to demands placed upon us.
I’m sure we all know the symptoms, but it is worth taking a moment to reflect on some of the common features:
- Difficulty getting to sleep or difficulty waking up in the morning;
- Constant fatigue;
- Aches and pains for no apparent reason;
- Poor appetite;
- Social withdrawal;
- Loss of interest in activities;
- Increased anxiety and irritability;
- “Flying off the handle”;
- Palpitations and raised blood pressure;
Here is a great little video by a Canadian doctor. It highlights the problems and brings out some of the key concepts in stress management. "The Single Most Important Thing You Can Do for Stress"
Please take some time to watch the video, reflect on it and then watch it again!
The key points are that you can change your thinking style and how you react to the situations you find yourself in. But you might need to learn techniques to do this and new skills to break away from patterns of established thinking and behaviour.
Remember, if you can’t change the situation (too many patients, too much paperwork, not enough time etc.) then you can change how you respond to it.
Here are some resources for stress management:
The BMA Wellbeing Support Services offers counselling and support for any doctor or medical student. Website: bma.org.uk/wellbeingsupport
How to be Happy is a video link you might find interesting. This video looks at some resilience and stress management tips. Website: https://www.youtube.com/watch?v=sycZZrYvCNw
Mind Tools is an interesting site that has lots of useful material. A lot is open access and contains material on stress management, project management, communication skills etc. You can find these in the toolkit section on the website. Website: https://www.mindtools.com/
Top Tips for Stress Busting Presentation - Contains links to the videos 'Signs and Symptom of Stress' and 'Stress Management Techniques'. Website: Wessex LMCs Stress Presentation
- The General Practitioner Health Program offers confidential mental health and addiction support for GPs and GP trainees across England. Website: http://gphealth.nhs.uk
- The Doctors Support Group (DSG) aims to provide support and assistance to any medical professional or dentist facing suspension, exclusion, investigation of complaints and/or allegations of professional misconduct Website: https://doctorssupportgroup.com/
- DOCHealth is a new confidential, not for profit, psychotherapeutic consultation service for all doctors. Website: https://www.dochealth.org.uk/ Telephone: 0207 383 6533
- NHS Practitioner Health Programme - The Wounded Healer 2018 Videos. 10 Year Anniversary Conference of the Practitioner Health Service. A selection of the keynote speeches and presentations from the 2018 conference. Website: https://php.nhs.uk/the-wounded-healer-2018-videos/ ???????
If you are undergoing a GMC investigation the BMA have a dedicated service to help manage the stress. Website: https://www.bma.org.uk/advice/work-life-support/your-wellbeing/doctor-support-service
A core part of the role of Wessex LMCs is pastoral support. The LMC offers one to one support for GPs and Practice Managers who might face a range of challenges from problems in the practice, health issues, personal problems at home, and include performance issues, either developing, or established, in terms of performance procedures with the Area Team or GMC. These processes can be extremely stressful, and GPs need to know that they can turn to us for confidential support whatever the problem.
With this in mind we have established the Wessex LMCs GP Support and Development Scheme (GPSD). Website: https://www.wessexlmcs.com/gpsd.
Dr Susan Kersley has worked as a coach since 1997 having taken early retirement in 1997 to work with stressed and overworked doctors. She has published widely and her book “Prescription for Change for doctors who want a life” is excellent, especially if you prefer physical material rather than web-based reading. She also wrote the BMJ series “ABC of change for doctors"
Try thinking in Terms of Resilience Rather than Stress Management. Increasingly experts in the field are turning to alternative views of traditional stress management and exploring how people can increase resilience to stress rather than trying to remove it or manage it.
“I have missed more than 9,000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot ... and I missed. I have failed over and over and over again in my life. And that's precisely why I succeed.” --Michael Jordan
This quote provides a glimpse into the idea of psychological resilience. Resilience is the ability to bounce back, survive, and even grow in the face of stress and adversity.
Stress management has been the focus of a great deal of discussion in terms of dealing with the challenges and changes in life. I’d like to suggest that focusing on developing resilience is a better use of resources than traditional stress management. Let’s take a look at the differences between the two.
Resilience vs. Traditional Stress Management
Resilience: Focus is on a solution Stress Management: Focus is on a problem
Resilience: Addresses personal strengths Stress Management: Addresses symptoms and deficits
Resilience: Stress viewed as normal and inevitable Stress Management: Stress viewed as pathological and destructive
Resilience: Problems are opportunities for growth Stress Management: Problems are an indication of failure
Resilience: Optimism and hope are the cause of success Stress Management: Optimism and hope are the result of success
Resilience: Happiness is the goal Stress Management: Coping is the goal
Focus is on a solution
When you focus on a solution rather than a problem, you have already begun to move forward in life. Focusing on solutions is proactive; focusing on problems is reactive. From your own experience you know that when you focus on a problem you are looking backward, evaluating the cause, asking why this happened to you and trying to figuring out who to blame. Focusing on a solution, on the other hand, allows you to use your energy to figure out how to move forward. Your focus is now on how to avoid the same problem in the future by looking at different paths to success.
Addresses personal strengths
As you confront the challenges and changes in your life, it is important to identify the tools you have available to successfully address the stressors you encounter. It is much easier to build on strengths than to fix weaknesses. When you focus on your personal liabilities, it is easy to begin to wallow in them, to allow them to define who you are. Focusing on deficits tends to interfere with your ability to understand your true strengths. Resilience, on the other hand, is based on your ability to identify, understand, grow and use your personal values, strengths, and abilities.
Stress as normal and inevitable
When you understand that life is about change and that challenges to your well-being are constantly occurring, you can begin to prepare for them, just as you do in any training scenario. Resilience involves accepting that stress is inevitable, that serious challenges to your well-being and changes in your life will occur. It then involves developing the tools that will help you succeed in the face of the many challenges you will face over the course of your life. This doesn’t mean developing a pessimistic view of life, but a realistic one. Stress is neither pathological nor destructive in the presence of a resilient response.
Problems are opportunities for growth
There are many lessons to be learned by overcoming problems. Imagine a child whose parent walks in front of him with a broom sweeping every pebble from his path so he won’t ever trip or fall or suffer any discomfort. Is there any chance that child will grow up to be capable and self-confident? While none of us seek out problems and stressors in life, they are a given part of our experience. Doesn’t it make sense to use them to our benefit whenever possible? Many trauma survivors experience what is called Post-Traumatic Growth, a positive change in perspective and confidence that ultimately leads to greater strength and wisdom as they continue with their lives. Many of your problems will present you with opportunities if you are able to see beyond the sense of failure and discomfort they can bring and focus instead on the lessons learned. While there are many young people who are smart, there are none who are wise. Wisdom requires learning through adversity over time.
Optimism and hope are the cause of success
An outlook on life that expects success is a powerful tool in your resilience armory. When you expect success and are hopefully expecting positive outcomes, setbacks and failures are seen as mere bumps in the road leading to inevitable success. Viewed realistically, failure doesn’t become a huge boulder blocking your way. If you are optimistic and hopeful only when you’ve been successful at something, what happens to you on the occasions you fail? Logic says you must then be pessimistic and hopeless. There is no way to find solutions under those circumstances, and failure will breed failure. Every successful person looks forward with hope, not with dread.
Happiness is the goal
Dealing with the inevitable challenges in life involves more than simply coping with stress. Resilience skills should lead to happiness. Focus on positive outcomes rather than settling for simply solving problems. Resilience skills and personal qualities improve relationships and create a sense of control over the direction of your life; these lead to happiness and provide the energy to thrive, even in the face of adversity.
Dr. Charles P. Bosmajian, Jr. is a psychologist at the National Center for Telehealth & Technology.