Dealing with Stress in Medical Practice Academia by zra16726

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									   Dealing with Stress in Medical Practice
                            & Academia

    “If you want to help your patients deal with their stress, you’re
    going to have to learn to handle your own.”
                               — Dr. Matthew Budd, Harvard University




Andrew L. Parker, Ph.D.
Faculty & Staff Assistance Program
 The Hard Truth:

Medical Practice
      Is a
Stress Machine
 Why Don’t We Choose To Manage Our
Stress Even When We Know What To Do?



             Stress
Common Stressors of Medical
    Practice at UCSF

1. Overworked & underpaid
2. Too much to do & too little time
3. More criticism than praise
4. Patient health & life at stake
5. Personal life often neglected
6. Competition for status & tenure
          Understanding Stress
 “Stress is the nonspecific response of the body to any demand made
 upon it” — Hans Selye, MD



 The   concept of Stress entered
  psychological & medical vocabularies from
  engineering with Hans Selye's work in
  1950's
 Stress is an environmental pressure, strain
  is its effect on something or someone
          Understanding Stress
 “Man should not try to avoid stress any more than he would shun
 food, love or exercise." — Hans Selye, MD




 Stress is a fact of life, a universal
  condition, and therefore unavoidable
 If we cannot eliminate stress, how can we
  come to terms with it?
        The Continuum of Stress
   Stress occurs along a continuum:
      No stress: promotes Stagnation — no challenge, no
       spur to action, no adaptation
      Prostress (or “Eustress”): promotes Growth —
       pleasant, challenging exciting conditions that offer
       fulfillment and arousal without the harmful
       consequences of negative stress.
      Distress: Negatively perceived event or trigger that
       promotes upset, suffering, illness — at the extreme it
       can lead to psychosis, even death
    The Continuum of Stress
Stress runs along a continuum from None to Total — neither
                     extreme is healthy




 Stagnation              Growth                    Death
          Understanding Stress
                  The Distress Reaction

1. Outpouring of adrenaline and other hormones
2. "Fight or flight" response
3. Impacts health by modulating rate of cellular aging
4. Increase in heart rate & blood pressure
5. Faster breathing
6. Muscle tension
7. Increased alertness and sensory sensitivity
8. Increased blood flow to brain, heart and muscles
9. Decreased blood flow to skin, digestive tract, kidneys and liver
10. Increase in blood sugar, fats and cholesterol
              Understanding Stress
                      Symptoms of Distress
   Physical:
       Fatigue, headaches, insomnia, muscle aches/stiffness, heart
        palpitations, chest pains, abdominal cramps, nausea, trembling,
        flushing, sweating, frequent colds
   Mental:
       Decreased concentration and memory, indecisiveness, racing
        thoughts, confusion, loss of humor
   Emotional:
       Anger (short temper, irritability, impatience), Anxiety
        (nervousness, worry, fear), Sadness (grief, anguish, depression)
   Behavioral:
       Pacing, fidgeting, nervous habits, increased eating, smoking,
        drinking or drug abuse, crying, yelling, swearing, throwing things
                Understanding Stress
                          Sources of Distress
   External:
        Physical Environment: noise, heat, bright lights, traffic
        Social: rudeness, bossiness, aggression
        Organizational: rules/regulations, red tape, deadlines, dysfunction
        Major life events: births, deaths, weddings, job loss, promotion
        Daily hassles: commuting, mechanical breakdowns, misplaced keys

   Internal:
        Lifestyle choices: caffeine, lack of sleep, overloaded schedule
        Negative self-talk: pessimistic thinking, self-criticism, over-analyzing
        Mind traps: unrealistic expectations, black-or-white thinking, over-
         personalizing, rigid standards
        Personality traits: perfectionism, workaholism, people-pleaser,
         “Type A”
     The Generic Model of Stress

      (Stimulus) Stressor  (Response) Strain

   This model assumes that all stimuli or stressors are the same
    and more or less affect everybody equally.

   The problem with this model is that one situation can be quite
    stressful for one person and not at all for another.

   How you respond is determined in part by the personal
    meaning you give to the stressor. Example: a crisis can be
    experienced by one person as a breakdown and by another as
    a breakthrough.
  Individualized Model of Stress
Environmental   Individual: beliefs,   Stress
frustrations,   personality,           Reactions:
losses, and     values, personal       prostress /
uncertainties   and medical            distress
                history, threats,      (physical)
                challenges, goals,     (cognitive)
                coping,                (behavioral)
                relationships,
                habits, sense of
                control, self-
                esteem,
                intelligence, and
                physical
                predispositions
         The Goal is Stress Optimization

      Optimizing stress has two aspects:
    1.    Managing External and Internal stress levels in order to stay
          within the Prostress range
    2.    Expanding the Prostress range by increasing tolerance for
          stress — through improved stamina, proactive (“wellness”)
          measures, mindfulness, etc.

    The body’s physical activation in response to optimal stress is
     actually beneficial — Selye called this the “general adaptation
     syndrome”.

    If the stress continues unrelieved, what happens is that the initially
     adaptive response begins to takes its toll, leading to what Selye
     calls the “wear and tear of stress.”

    If you interpret stress positively and handle it “actively,” you won’t
     have the long-term, particularly harmful physical activation that
     coincides with negative stress — i.e., distress.
 Stress Management Strategies
                    Lifestyle Changes

1. Decrease or discontinue caffeine
2. Regular exercise
3. Relaxation/Meditation
4. Sufficient Sleep
5. Time-outs and Leisure (pacing & work/leisure balance)
6. Realistic expectations
7. Reframing/Reinterpreting stressful situations
8. Belief/Value systems
9. Ventilation/Support system
10. Humor
11. Balanced diet
Stress Management Strategies
               Situational Changes



1. Time and money management
2. Practicing healthy assertiveness in social
   relationships
3. Creative Problem-solving
4. Consider leaving a job or relationship that
   has become unsustainable or destructive
Stress Management Strategies
            Cognitive Changes



  1. See problems as opportunities
  2. Refute negative thoughts
  3. Focus on the positives
  4. Take the long-term view
           Being “Stress-Wise”


     Being “Stress-Wise” is being open to
    interpreting difficult situations as positive
    and growth-promoting opportunities and
    actively seeking out such situations,
    while consciously monitoring oneself for
    signs of slipping into distress and actively
    working to ensure they don’t become too
    prolonged and harmful

								
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