Stress Management
Or
not
What Am I Going to Do?
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Big subject.
Think about what we mean by stress.
Think about why things stress us.
Look at some evidence about stress and
doctors.
• Suggest some ways of reducing its
deleterious effects.
August 2001
Bruce Davies
2
What do we mean by stress?
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Biological meaning
Social meanings
Medical meanings
Media meanings
• Real or imaginary?
August 2001
Bruce Davies
3
New Problem or Old?
• Perceptions.
• “Modern life.”
• Is war, poverty or
crime stressful?
• Stressors for me,
stimulation for you.
• Physiological
endpoints are the
same.
August 2001
Bruce Davies
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performance
Stress: problem or motivator
100
90
80
70
60
50
40
30
20
10
0
Stress
August 2001
Bruce Davies
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Effects of Stress
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Physical.
Mental.
Social.
Societal.
August 2001
Bruce Davies
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What Evidence Is There?
• More than you’d
think.
• Must remember all the
“non-medical
sources”.
• What follows is a
quick summary of the
more important doctor
specific research.
August 2001
Bruce Davies
7
Evidence
• Main stresses are.
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The demands of the job,
Patient expectations,
Interference with family life,
Interruptions at work.
Work at home.
Dealing with administration.
• May be substantial benefit in providing a
counselling service for GPs.
August 2001
Bruce Davies
8
Evidence
• 10 minute appointments put general
practitioners under less stress when
compared with the doctors' usual booking
intervals of between 5 and 7.5minutes.
• Stress can cause burnout or “rustout”.
• It seems to be getting worse.
August 2001
Bruce Davies
9
Evidence
• GPs doing more paperwork at home then
they and report more exhaustion or stress at
the end of a working week.
August 2001
Bruce Davies
10
Recognising Symptoms
• Physical signs.
• Emotional signs.
• Behavioural signs.
August 2001
Bruce Davies
11
Taking Control
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Work pattern.
Home / work.
Work environment.
Managing time.
Routines of work.
August 2001
Bruce Davies
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Expectations
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Cultural differences.
Learning to say no.
Setting your standards.
The work play dichotomy.
August 2001
Bruce Davies
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Exercise
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At work.
At home.
Learning to relax.
Why does it help?
August 2001
Bruce Davies
14
Time Out
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Housekeeping.
Gaps.
DNAs
Other work.
Holidays.
August 2001
Bruce Davies
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Hobbies
• Outside interests.
• If medicine your life – do they matter?
• Why helpful?
August 2001
Bruce Davies
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Solutions ?
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T aking control
E xpectations
E xercise
T ime out
H obbies
August 2001
Bruce Davies
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PROFESSIONAL BURNOUT
D Kelly Update 15th June 1992 1163-1170
• Clear-cut, lucid and succinct description of
the symptoms, treatment and preventative
measures. Terrific
August 2001
Bruce Davies
18
Stress Management
Does Talking About It, and Studying
It Make It Worse?
Last Thoughts.
Good trend:
Computers allow us to work
100% faster
Unexpected bad thing:
Computers generate 300%
more work.
Women get more political
power.
Women are as dumb as men.
Music continues to get
better.
I get old.
August 2001
Bruce Davies
20
Thankyou
August 2001
Bruce Davies
21
MENTAL HEALTH, JOB SATISFACTION
AND JOB STRESS AMONG GENERAL
PRACTITIONERS
C Cooper et al BMJ 1989; 298: 366-70
• Main stresses are the demands of the job,
patient expectations, interference with
family life, interruptions at work and home
and dealing with administration. Concludes
that there may be substantial benefit in
providing a counselling service for GPs
(and other health workers.)
August 2001
Bruce Davies
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LONGER BOOKING INTERVALS IN GENERAL
PRACTICE: EFFECTS ON DOCTORS' STRESS
AND AROUSAL
A Wilson et al BJGP 1991; 41: 184-7
• 10 minute appointments put general
practitioners under less stress when
compared with the doctors' usual booking
intervals of between 5 and 7.5minutes
August 2001
Bruce Davies
23
TO BURN OUT OR RUST OUT IN
GENERAL PRACTICE?
TC O'Dowd JRCGP 1987; 37: 290
August 2001
Bruce Davies
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JOB STRESS, SATISFACTION, AND MENTAL HEALTH
AMONG GENERAL PRACTITIONERS BEFORE AND
AFTER INTRODUCTION OF NEW CONTRACT
VJ Sutherland and CL Cooper BMJ 1992;
304: 1545-8
• Comparing 1987 with 1990, GPs
experienced more stress from night calls,
emergencies during surgery hours and
interruption of family life by the telephone.
Somatic anxiety and depression were both
higher and job satisfaction had also
decreased.
August 2001
Bruce Davies
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PSYCHOLOGICAL STRESSES OF BEING A
DOCTOR
P Whewell Update 1st June 1992 pp1003-4
(references continued on p1071)
• A review of the problems with some
suggestions for coping and finding help.
August 2001
Bruce Davies
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PROFESSIONAL BURNOUT
D Kelly Update 15th June 1992 1163-1170
• Clear-cut, lucid and succinct description of
the symptoms, treatment and preventative
measures. Terrific
August 2001
Bruce Davies
27
WORK PATTERNS OF GENERAL
PRACTITIONERS BEFORE AND AFTER THE
INTRODUCTION OF THE 1990 CONTRACT
R Chambers and J Belcher BJGP 1993; 43:
410-12
• This paper indicates the changes resulted in
GPs doing more paperwork at home and
reporting exhaustion or stress at the end of a
working week.
August 2001
Bruce Davies
28
STRESS, ANXIETY AND DEPRESSION IN HOSPITAL
CONSULTANTS, GENERAL PRACTITIONERS, AND
SENIOR HEALTH SERVICE MANAGERS
RP Caplan BMJ 1994; 309: 1261-3
• A worrying, but not surprising set of results.
Action detectable anywhere? What
interventions might work? What
interventions have been shown to work?
August 2001
Bruce Davies
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