Stress is rampant among doctors.How to deal with it.Dr.Jaikumar shares some of the tips of his trade!

1. Dr.KMH-IMA
Dr.Jaikumar(Psychiatrist)

2. Little education; evidence building
30-60% MD have distress and burnout
MDs suicide > other prof. & gen pop.
One physician per day; PhD – unclear
Grossly underestimated
Depression/bipolar & substance abuse = suicide risk
“Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz,
2009.

3. Academic faculty:
Worked longer hours
Took less vacation
10% with mild depression
27% with elevated anxiety
No sig difference clinical vs. academic
Litigation/named in law suite
Lin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA
254(19):2775-82.
Schindler et al. The Impact onof the changing Health Care Environment on the Health and Well-being of faculty at Four Medical
Schools. Academ Med 2006 81(1):27-34.

5. OBSESSIVENESS
COMPULSIVENESS
EXAGGERATED SENSE OF RESPONSIBILITY
CHRONIC FEELINGS OF NOT DOING ENOUGH
DIFFICULTY SETTING LIMITS

6. The ability to delay personal and pleasurable self
interests until more important goals are achieved
DOCTORS are MASTERS of this
The ability to delay attending to significant
relationships and other sources of renewal until all
the work is done BUT

8. Traditionally, doctors were men who were
often married to a homemaker
Today:
1/3 of doctors are women
½ of medical students are women
Women struggle more with balancing home and
work responsibilities

9. LONGER HOURS
MORE PAPERWORK
DECREASING COMPENSATION
STRINGENT GOVERNMENT AND INSURANCE
REGULATIONS
MALPRACTICE ACCUSATIONS

10. Diminished Immunity
Headache
Fatigue
Weight gain
Dyslipidemia
Hypertension
Heart Disease
Psoriasis/Eczema
Digestive problems

11. Depression
Alcoholism
Substance abuse
Anxiety
Insomnia
Irritable bowel
syndrome
Fibromyalgia
Decreased sex
drive

12. Stress: A state of disharmony or a threat to
homeostasis
Physiological changes increase alertness, focus, and
energy
Perceived demands may exceed the perceived
resources
Coping: The ability to maintain control, think
rationally, and problem solve
Resilience: Resistant quality that permits a person
to recovery quickly and thrive in spite of adversity

13. ACUTE STRESS- immediate response to a
threat or stressor
CHRONIC STRESS:
-long term acute stress
-More subtle but lasting
-Nagging
-Unrelenting

14. External causes
Family, work, economics, work, school, major
life changes, unforeseen events, etc.
Internal causes
Worry, uncertainty, fear, attitudes, unrealistic
expectations, etc.

15. Alarm—when one feels threatened
Activation of the fight or flight reaction
Resistance—mobilization of resources to
solve the problem
Continued stress causes adaptation
Exhaustion
Adaptation fails and level of function decreases

16. The cumulative result of
unaddressed stress
A state of physical, emotional
and mental exhaustion
“an erosion of the soul”
“silent anguish of the healers”
A relationship gone bad

17. Grows gradually over time
Perhaps beginning in medical school
or residency
Disillusioned
Cynical
It becomes very difficult to do a
competent job

18. Personal and family
losses
Decreased
productivity
Medical mistakes
Physician turnover

19. “Frustrated physicians find careers outside of
medicine”
“Suicide rate of women doctors in US is twice that of
other working women”
“Suicide rate high in female doctors”
“Many doctors prone to stress”

20. Adaptive Coping
Contribute to resolution of the stress response
Maladaptive Coping
Strategies that cause further problems
Active Coping
Actively seeking resolution to the stress

21. 1)Physician’s personal
responsibility
(INTRINSIC) but should
include
2)help from the
workplace (EXTRINSIC)
Should start in medical
school! and continue
through retirement
In 2001, the Joint
Commission mandated
that hospitals address
physician well-being

22. -Listen to your SELF TALK
-Are you content and satisfied?
-Are you always complaining to yourself?
-What causes you to feel stressed?
-What makes you happy? Are you happy?
Are you irritable? Anxious? Depressed?

23. How are your relationships going?
Is your practice going well? Is it what you
expected?
What is your body telling you?
-Are you tired?
-Do you get enough sleep?
-Do you have headaches? Back pain?

24. Training
Prepares for stressful events
Nutrition
Eat healthy, avoid skipping meals
Exercise
Include regular exercise
Sleep
Get adequate sleep—avoid fatigue

25. Blurring of
boundaries
Avoidance/withdraw
al
Negative attitude
Anger outbursts
Alcohol/Drugs
Hopelessness
Negative self-talk
Resentment
Violence

26. Positive Role
Models
Optimism
Humor
Moral Compass
Altruism
Religion &
Spirituality
Social Support

27. Work on self
acceptance-let go of
perfection as a goal
Autonomy-internal
locus of self-
evaluation
Always work
towards personal
growth

28. -Not only for life outside of work
-Work does not have to be merely a domain of energy
expenditure but also of energy renewal
-Learn to receive support, healing and meaning while
giving

29. Decrease level of arousal and moderate the
stress response
Decrease feelings of tension and arousal
Increase sense of well-being and
peacefulness
Increase sense of personal control
EASY to learn. EASY to do.

30. Realistic expectations
Set realistic goals
Planning
Anticipate problems, have a backup plan
Reframing
Change the way you look at things
Relaxation
Learn relaxation techniques, take time-out for leisure
Discuss the problem
Utilize existing social supports to problem solve

31. Highly effective
Mature coping mechanism
“Another of the souls’ weapons for the fight
for self-preservation, it is well known that
humor, more then anything else in the human
makeup, can provide an aloofness and the
ability to rise above any situation, even for a
few seconds.”
Viktor Frankl

32. Conduct a moral inventory
“Look not for any greater harm then this,
destroying the trustworthy, self-respecting,
well-behaved man within you.”
Epicetus
Maintain your integrity
“Between stimulus and response there is a
space. In that space is our power to choose our
response. In our response lies our growth and
our freedom.”
Viktor
Frankl

33. Unselfish regarding the welfare of others
Believe in a meaningful cause
Mutual cooperation
Activates of the brain’s reward center

34. Associated with psychological and
physical well being
Guards against despair
Provides social support
Provides positive role models
Provides a positive mission

35. Social support has a
profound effect on
life expectancy
Patients have better
outcomes with strong
social support
Isolation and poor
social support are
associated with a
poor stress response
Few hardy individuals
“go it alone”

36. Positive Beliefs
Associated with well being
Cognitive reframing
Positive thinking
Refute the negative thinking
Believe in a meaningful cause
It is important to acknowledge relevant
negative factors

44. Fostered by
MEDITATION
Being fully present in
the moment, to the
person and the task at
hand
COUNTERBALANCE for
all the interrupted
tasks and competing
demands common to
most work days

45. Establish a Physician
Health Committee
Mentor program
Confidential support
groups
Annual well-being
retreat

46. Look at a physicians sense of meaning in their work
and not just productivity
Membership to fitness clubs
CME on topics related to well-being
Flexible schedules
Decrease paperwork