Stress Management Or not August 2001Bruce Davies2 What Am I Going to Do? Big subject. Think about what we mean by stress. Think about why things stress.

Stress ManagementStress ManagementOr

not

August 2001 Bruce Davies 2

What Am I Going to Do?What Am I Going to Do?

• 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 3

What do we mean by stress?What do we mean by stress?

• Biological meaning• Social meanings• Medical meanings• Media meanings

• Real or imaginary?

August 2001 Bruce Davies 4

New Problem or Old?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 5

Stress: problem or motivatorStress: problem or motivator

0102030405060708090

100

Stress

perf

orm

ance

August 2001 Bruce Davies 6

Effects of StressEffects of Stress

• Physical.

• Mental.

• Social.

• Societal.

August 2001 Bruce Davies 7

What Evidence Is There?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 8

EvidenceEvidence

• Main stresses are.– 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 9

EvidenceEvidence

• 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 10

EvidenceEvidence

• 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 11

Recognising SymptomsRecognising Symptoms

• Physical signs.

• Emotional signs.

• Behavioural signs.

August 2001 Bruce Davies 12

Taking ControlTaking Control

• Work pattern.

• Home / work.

• Work environment.

• Managing time.

• Routines of work.

August 2001 Bruce Davies 13

ExpectationsExpectations

• Cultural differences.

• Learning to say no.

• Setting your standards.

• The work play dichotomy.

August 2001 Bruce Davies 14

ExerciseExercise

• At work.

• At home.

• Learning to relax.

• Why does it help?

August 2001 Bruce Davies 15

Time OutTime Out

• Housekeeping.

• Gaps.

• DNAs

• Other work.

• Holidays.

August 2001 Bruce Davies 16

HobbiesHobbies

• Outside interests.

• If medicine your life – do they matter?

• Why helpful?

August 2001 Bruce Davies 17

Solutions ?Solutions ?

• T aking control

• E xpectations

• E xercise

• T ime out

• H obbies

August 2001 Bruce Davies 18

PROFESSIONAL BURNOUTPROFESSIONAL BURNOUT

D Kelly Update 15th June 1992 1163-1170

• Clear-cut, lucid and succinct description of the symptoms, treatment and preventative measures. Terrific

Stress ManagementStress ManagementDoes Talking About It, and Studying

It Make It Worse?

August 2001 Bruce Davies 20

Last Thoughts.Last Thoughts.

Good trend: Unexpected bad thing:

Computers allow us to work

100% faster

Women get more political power.

Music continues to get better.

Computers generate 300% more work.

Women are as dumb as men.

I get old.

August 2001 Bruce Davies 21

Thankyou

August 2001 Bruce Davies 22

MENTAL HEALTH, JOB SATISFACTION MENTAL HEALTH, JOB SATISFACTION AND JOB STRESS AMONG GENERAL AND JOB STRESS AMONG GENERAL PRACTITIONERSPRACTITIONERS

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 23

LONGER BOOKINGLONGER BOOKING INTERVALS IN GENERAL INTERVALS IN GENERAL PRACTICE: EFFECTS ON DOCTORS' STRESS PRACTICE: EFFECTS ON DOCTORS' STRESS AND AROUSALAND 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 24

TO BURN OUT OR RUST OUT IN TO BURN OUT OR RUST OUT IN GENERAL PRACTICE?GENERAL PRACTICE?

TC O'Dowd JRCGP 1987; 37: 290

August 2001 Bruce Davies 25

JOB STRESS, SATISFACTION,JOB STRESS, SATISFACTION, AND MENTAL HEALTH AND MENTAL HEALTH

AMONG GENERAL PRACTITIONERS BEFORE AND AMONG GENERAL PRACTITIONERS BEFORE AND AFTER INTRODUCTION OF NEW CONTRACTAFTER 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 26

PSYCHOLOGICAL STRESSES OF BEING A PSYCHOLOGICAL STRESSES OF BEING A DOCTORDOCTOR

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 27

PROFESSIONAL BURNOUTPROFESSIONAL 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 28

WORK PATTERNS OFWORK PATTERNS OF GENERAL GENERAL PRACTITIONERS BEFORE AND AFTER THE PRACTITIONERS BEFORE AND AFTER THE INTRODUCTION OF THE 1990 CONTRACTINTRODUCTION 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 29

STRESS, ANXIETY AND DEPRESSION IN HOSPITAL STRESS, ANXIETY AND DEPRESSION IN HOSPITAL CONSULTANTS, GENERAL PRACTITIONERS, AND CONSULTANTS, GENERAL PRACTITIONERS, AND SENIOR HEALTH SERVICE MANAGERSSENIOR 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?