Getting in the zone, recognising our personal stress limits and looking after ourselves are vital components in our efforts to stay healthy advises Abbie Lane, after almost a generation of de-stressing others.
They say a rugby player like Brian O’Driscoll or Dan Carter only comes along once in a life-time. He has skill, performs consistently to a high standard, is mentally strong and makes good decisions even when under pressure. He has a strong work ethic, both in training and in play, and is able to adapt in a variety of environments. Although a gifted individual he remains very much a team player, who also possesses leadership qualities.
In effect he has all the attributes that are required by medical professionals. Most of us are expected to perform to extremely high levels every day of our working lives. Often high expectations are placed on us and we face the glare of adverse publicity if the outcome is poor or if mistakes are made. It is therefore not surprising that doctors can get worn out and unwell due to work.
The levels of illness in medical professionals are 20, and in some cases, 60% higher than the general population no matter what speciality or level of seniority. These findings are consistent across all studies and all countries with the highest suicide rates in anaesthetics and psychiatry. The World Health Organization refers to stress as the ‘Health Epidemic of the 21st Century’ and predicts that by 2020 five of the top diseases world-wide will be stress related. This translates to us all having a one in four chance of developing a stress related illness in our life time.
“Each of us has our own ‘optimum’ level of stress where the level of pressure we come under activates us and we perform to the best of our ability.”
But whether we love it or hate it, we all need stress in our lives. The key is in keeping it manageable. There is a direct relationship between the amount of stress we experience and our performance; with too little stress we can be too laid back and under-perform, with too much stress we can become overwhelmed and risk illness and burnout. Get it right and we thrive.
Each of us has our own ‘optimum’ level of stress where the level of pressure we come under activates us and we perform to the best of our ability. This is called being ‘in the zone’, like the athlete before a race or ourselves before a deadline or performance.
When I started to work in this area over 20 years ago, stress wasn’t considered that harmful and instead looked on as something that everyone experienced and just needed to get on with, lean in, pull up the socks and so on.
We now have firm evidence of the link between stress and illness. It is known to be related to anxiety and panic, fatigue and burnout, mood disorders and suicide. Even the more genetic or the inherited types of mental illness such as bipolar mood disorder and schizophrenia can be precipitated and aggravated by stress.
There are links between stress and physical illness, particularly cardiac illness, high blood pressure, heart attacks, obesity, gastro-intestinal illness, inflammatory disorders of the bowel, joints and skin. Even some cancers may be aggravated by stress. Recently, it has been linked to premature ageing and brain shrinkage. Stress is also linked to increased alcohol intake, other substance use and smoking as well as the potential for accidents and these bring their own health risks.
We can inherit a vulnerability to stress, for example some people are ‘born worriers’ and can experience stress easier than others but the biology /genetics is a small part overall. A lot of stress is very individual, the way we think or cope, our resilience levels, our approach to life (optimism versus pessimism), the environment we live in, the pressures we come under, our ability to cope with adversity and change, our life-style habits (nutrition, exercise, interests, alcohol use), the support around us, our relationships and our general health and finances.
“Managing stress is within our control and help is available.”
Our colleges, training bodies and workplaces are all aware of the importance of managing physician health and increasingly are putting health and wellness initiatives in place, but there is much that we can do on a personal level to manage our health and resilience.
The earlier one identifies the problems the easier it is to reverse and prevent. Sleep difficulties, low energy, fatigue, lack of enjoyment, impaired decision making and concentration problems along with irritability are often the first signs. Many describe it as not feeling as ‘sharp’ or feeling overwhelmed, anxious, fearful or worried.
It is important that we have an idea of our own stress capacity and identify when we move to excessive pressure. The idea behind making stress work to our advantage is to put ourselves under enough pressure to get the job done but to then give ourselves time to recover and rebuild our reserves before the next pressure situation. Again, think of the athlete giving time for recovery between events.
The recommended approach to stress management is to look at lifestyle and healthy habits and self-help as a first step. This improves resilience and enhances our ability to withstand stress. Therapy can be helpful and this is usually cognitive behaviour therapy or CBT that looks at thinking and personality traits. Medication may be considered if the problem persists despite these inputs. The medication used is usually an anti-depressant which also helps with anxiety and is non-addictive and is not a tranquilliser or sedating. People will usually take it for a period of 12 to 18 months. Medication often brings faster relief from the distress and is usually needed when the person is depressed or suicidal or unable to function.
A key lifestyle stress buster is taking regular breaks in the day. We were not built for sustained focussed activity so breaks of five minutes every hour or so really do help. It is even better if this includes getting some fresh air and natural light especially if we work in artificially lighted or ventilated areas. Remember to keep refuelled with regular meals and at least two litres of water a day and try to get some exercise. Thirty minutes brisk exercise five times a week is what keeps stress at bay and prevents physical and mental illness. To combine it with a more reflective activity such as mindfulness, t’ai chi or yoga produces greater benefits. Keep alcohol to a minimum and learn to say ‘no’ to demands and you will be well on your way to managing stress. The Headspace app is a good resource as well as online Buddhify and Smiling Mind for mindfulness and www.futurelearn.com for free online stress management courses.
All this should help but if you find yourself increasingly anxious, lacking enjoyment, with low energy or feeling hopeless or that life is not worth living then do seek help. Talking to your GP is usually the first step and they should be able to access the problem and direct you along the best care path.
Working in healthcare, delivering to the public, working long hours with high levels of responsibility and the potential for public repercussions of mistakes is potentially stressful. Managing stress is within our control and help is available. Remember stress is common and not a sign of failure or weakness. Look after yourself!
Beyond Blue: The National Depression Initiative. The mental health of doctors: a systematic review of the literature. Victoria, Australia; Beyond Blue; 2010.
The Stress Handbook: managing stress for healthy living. Dublin, Ireland; Orpen Press; 2018.
Declaration of competing interests: None declared.